Skip to main content
SpringerLink
Log in

Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Target specific anticoagulants (TSOACs) have recently been introduced to the US market for multiple indications including venous thromboembolism (VTE) prevention in total hip and knee replacement surgeries, VTE treatment and reduction in the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Currently, three TSOACs are available including rivaroxaban, apixaban, and dabigatran with edoxaban currently under Food and Drug Administration review for VTE treatment and stroke prevention in NVAF. The introduction of these agents has created a paradigm shift in anticoagulation by considerably simplifying treatment and anticoagulant initiation for patients by giving clinicians the opportunity to use a rapid onset, rapid offset, oral agent. The availability of these rapid onset TSOACs is allowing for outpatient treatment of low risk pulmonary embolism and deep vein thrombosis which can greatly reduce healthcare costs by avoiding inpatient hospitalizations and treatment for the disease. Additionally with this practice, the complications of an inpatient hospitalization may also be avoided such as nosocomial infections. Single-agent approaches with TSOACs represent a paradigm shift in the treatment of VTE versus the complicated overlap of a parenteral agent with warfarin. Transitions between anticoagulants, including TSOACs, are a high-risk period for the patient, and clinicians must carefully consider patient characteristics such as renal function as well as the agents that are being transitioned. TSOAC use appears to be growing slowly with improved payment coverage throughout the US.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lu G, DeGuzman FR, Hollenbach SJ, Karbarz MJ, Abe K, Lee G, Luan P, Hutchaleelaha A, Inagaki M, Conley PB, Phillips DR, Sinha U (2013) A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Nat Med 19(4):446–451. doi:10.1038/nm.3102

    Article  CAS  PubMed  Google Scholar 

  2. Schiele F, van Ryn J, Canada K, Newsome C, Sepulveda E, Park J, Nar H, Litzenburger T (2013) A specific antidote for dabigatran: functional and structural characterization. Blood 121(18):3554–3562. doi:10.1182/blood-2012-11-468207

    Article  CAS  PubMed  Google Scholar 

  3. Mahan CE, Fanikos J (2011) New antithrombotics: the impact on global health care. Thromb Res 127(6):518–524. doi:10.1016/j.thromres.2011.03.022

    Article  CAS  PubMed  Google Scholar 

  4. Weitz JI, Eikelboom JW, Samama MM, American College of Chest P (2012) New antithrombotic drugs: antithrombotic therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e120S–e151S. doi:10.1378/chest.11-2294

    PubMed Central  CAS  PubMed  Google Scholar 

  5. http://www.xareltohcp.com/sites/default/files/pdf/xarelto_0.pdf-zoom=100. Xarelto Package Insert. Accessed 12 Feb 2014

  6. http://packageinserts.bms.com/pi/pi_eliquis.pdf. Eliquis Package Insert. Accessed 12 Feb 2014

  7. http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/PrescribingInformation/PIs/Pradaxa/Pradaxa.pdf. Pradaxa Package Insert. Accessed 12 Feb 2014

  8. http://www.daiichisankyo.com/media_investors/media_relations/press_releases/detail/006065.html. Edoxaban FDA submission. Accessed 12 Feb 2014

  9. http://www.portola.com/clinical-development/andexanet-alfa-prt4445-fxa-inhibitor-antidote/. Andexanet Alpha Xa Reversal Agent. Accessed 12 Feb 2014

  10. http://www.boehringer-ingelheim.com/news/news_releases/press_releases/2014/19_november_2014dabigatranetexilateaha.html. Idarucizumab–Pradaxa Reversal Agent. Accessed 12 Feb 2014

  11. http://www.jnj.com/news/all/Janssen-Expands-EXPLORER-Global-Cardiovascular-Research-Program-to-Evaluate-the-Role-of-XARELTO-in-Addressing-Critical-Medical-Needs. Rivaroxaban research programs. Accessed 12 Feb 2014

  12. http://clinicaltrials.gov/ct2/results?term=apixaban&Search=Search. Apixaban clinical trials. Accessed 12 Feb 2014

  13. http://clinicaltrials.gov/ct2/results?term=rivaroxaban&Search=Search. Rivaroxaban clinical research. Accessed 12 Feb 2014

  14. Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, European Heart Rhythm A (2013) European heart rhythm association practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 15(5):625–651. doi:10.1093/europace/eut083

    Article  PubMed  Google Scholar 

  15. Hokusai VTEI, Buller HR, Decousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, Raskob GE, Schellong SM, Schwocho L, Segers A, Shi M, Verhamme P, Wells P (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369(15):1406–1415. doi:10.1056/NEJMoa1306638

    Article  Google Scholar 

  16. Bang OY, Hong KS, Heo JH, Koo J, Kwon SU, Yu KH, Bae HJ, Lee BC, Yoon BW, Kim JS (2014) New oral anticoagulants may be particularly useful for asian stroke patients. J Stroke 16(2):73–80. doi:10.5853/jos.2014.16.2.73

    Article  PubMed Central  PubMed  Google Scholar 

  17. Source: IMS Health National Prescription Audit, data through 11/14/14. Courtesy Janssen Pharmaceuticals 12/1/2014

  18. http://www.eliquis.com/eliquis/support-coverage-assistance. Apixaban coverage. Accessed 12 March 2014

  19. http://www.xareltohcp.com/formulary-map.html. Xarelto formulary map. Accessed 12 March 2014

  20. http://www.xareltohcp.com/access-affordability/access-affordability.html. Xarelto Access and Affordability. Accessed 12 March 2014

  21. http://www.pradaxapro.com/pradaxalink/dabigatran-coverage-affordability. Pradaxa coverage. Accessed 12 March 2014

  22. http://www.fingertipformulary.com/drugs/Eliquis/. Eliquis Coverage by State. Accessed 12 March 2014

  23. http://www.xareltocarepath.com/reducing-stroke-risk/xarelto-savings-programs. Xarelto savings programs. Accessed 12 March 2014

  24. http://www.eliquis.com/eliquis/support-offers. Eliquis support programs. Accessed 12 March 2014

  25. http://www.pradaxa.com/patient-support/pradaxalink.html. Pradaxa support programs. Accessed 12 March 2014

  26. http://oig.hhs.gov/fraud/docs/alertsandbulletins/2014/SAB_Copayment_Coupons.pdf. Office of inspector general special advisory bulletin. Accessed 12 March 2014

  27. Abo-Salem E, Becker R (2014) Transitioning to and from the novel oral anticoagulants: a management strategy for clinicians. J Thromb Thrombolysis 37(3):372–379. doi:10.1007/s11239-014-1060-y

    Article  CAS  PubMed  Google Scholar 

  28. Atay JK, Fiumara K, Piazza G, Fanikos J, Goldhaber SZ (2012) Hospital budget implications of substituting dabigatran for warfarin in an anticoagulation service. Clin Appl Thromb/Hemost 18(2):181–184. doi:10.1177/1076029611416642

    Article  CAS  Google Scholar 

  29. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R, College American, Chest P (2012) Perioperative management of antithrombotic therapy: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e326S–e350S. doi:10.1378/chest.11-2298

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Spinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM, Investigators EA-T (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369(22):2093–2104. doi:10.1056/NEJMoa1310907

    Article  CAS  PubMed  Google Scholar 

  31. Dawes J, Prowse CV, Pepper DS (1986) Absorption of heparin, LMW heparin and SP54 after subcutaneous injection, assessed by competitive binding assay. Thromb Res 44(5):683–693

    Article  CAS  PubMed  Google Scholar 

  32. Mahan CE, Borrego ME, Woersching AL, Federici R, Downey R, Tiongson J, Bieniarz MC, Cavanaugh BJ, Spyropoulos AC (2012) Venous thromboembolism: annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates. Thromb Haemost 108(2):291–302. doi:10.1160/TH12-03-0162

    Article  CAS  PubMed  Google Scholar 

  33. http://www.health.gov/hai/prevent_hai.asp. Nosocomial infections. Accessed 12 May 2014

Download references

Acknowledgments

Charles Mahan has received investigator-initiated grants from Sanofi-Aventis and funding from the North American Thrombosis Forum Traveling Fellowship Award, served as a consultant for Point of Care Software Solutions, Sanofi-Aventis, Boehringer-Ingelheim, Johnson & Johnson, Polymedix Inc., Leo, Eisai, and Daiichi Sankyo. He has served as a speaker for Janssen, Bristol Myers Squibb, Phizer, Sanofi-Aventis, and Boehringer Ingelheim.

Author information

Authors and Affiliations

  1. Presbyterian Healthcare Services, University of New Mexico, 1100 Central Ave. SE, Albuquerque, NM, 87106, USA

    Charles E. Mahan

Authors
  1. Charles E. Mahan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles E. Mahan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahan, C.E. Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment. J Thromb Thrombolysis 39, 295–303 (2015). https://doi.org/10.1007/s11239-014-1164-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-014-1164-4

Keywords

Search

Navigation