Julie K. Atay

Anticoagulation in patients with pulmonary arterial hypertension: An update on current knowledge.

Pulmonary hypertension is a severe clinical condition characterized by molecular and anatomic changes in pulmonary circulation. It is associated with increased pulmonary vascular resistance, which leads to right-sided heart failure if left untreated and, ultimately, death. Treatment of patients with pulmonary arterial hypertension (PAH) involves a complex strategy that takes into consideration disease severity, general and supportive measures, and combination drug regimens. Abnormalities of blood coagulation factors, anti-thrombotic factors, and the fibrinolytic system may contribute to a prothrombotic state in patients with idiopathic PAH. These physiologic changes, in concert with the presence of non-specific risk factors for venous thromboembolism such as heart failure and immobility, are thought to be the basis for oral anticoagulation in PAH. Several observational studies provide helpful information in favor of anticoagulation use in idiopathic PAH but not in other pulmonary hypertension etiologies. Guideline recommendations are based on the lack of prospective comparative trials in this regard. For that reason, large differences exist in the use of anticoagulants in different countries and centers. More studies should be carried out to clarify the risks and the potential benefits of anticoagulant use in a heterogeneous population of patients who are already at considerable life risk.

Hospital Budget Implications of Substituting Dabigatran for Warfarin in an Anticoagulation Service

The aim of our study was to assess hospital budget implications of substituting dabigatran for warfarin in patients enrolled in a large anticoagulation service. The study population was identified using criteria from randomized controlled trials of dabigatran. We obtained labor costs (

Dabigatran: a review of clinical and pharmacoeconomic evidence.

483 per patient) from the hospital’s anticoagulation service budget, laboratory costs of international normalized ratio (INR) tests (

Implementation of a Hemostatic and Antithrombotic Stewardship program

267 per patient), and wholesale costs of warfarin 5 mg tablets (

Effect of Dabigatran on Referrals to and Switching From Warfarin in Two Academic Anticoagulation Management Services

31 per patient) and dabigatran 150 mg capsules (

Parenteral Anticoagulants: Special Considerations in Patients with Chronic Kidney Disease and Obesity

2464 per patient). A total of 1774 (93.5%) of 1898 patients were eligible to substitute dabigatran for warfarin. The annual projected hospital expense for anticoagulation with dabigatran was

RETROSPECTIVE ANALYSIS OF MANAGEMENT OF BLEEDING COMPLICATIONS IN PATIENTS TAKING TARGET SPECIFIC ORAL ANTICOAGULANTS AT A LARGE TERTIARY ACADEMIC MEDICAL CENTER

4 371 136, attributable to drug cost alone. The annual projected cost of warfarin management was

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center

1 385 494. This was comprised of

Recombinant Factor VII Activated and Prothrombin Complex Concentrate Use at a Tertiary Academic Medical Center

856 842 for labor,

Improving Anticoagulation Management In Patients With Atrial Fibrillation

473 658 for INR testing, and