Final Thoughts and Conclusions on Novel Anticoagulants

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The MD Magazine Peer Exchange “Novel Anticoagulation Options: Target-Specific Oral Agents and Their Antidotes” features leading physician specialists discussing key topics in anticoagulation therapy, including the clinical characteristics of current and emerging agents and criteria for use in specific patient populations.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Scott Kaatz, DO, MSc, Chief Quality Officer at Hurley Medical Center in Flint, Michigan, and clinical associate professor at Michigan State University
• Seth Bilazarian, MD, clinical and interventional cardiologist at Pentucket Medical and instructor of medicine at Harvard Medical School
• Gerald Naccarelli, MD, Bernard Trabin Chair in Cardiology, professor of medicine and chief of the Division of Cardiology at Penn State University School of Medicine, and associate clinical director at Penn State Heart and Vascular Institute in Hershey, Pennsylvania
• Christian T. Ruff, MD, associate physician in the cardiovascular medicine division at Brigham and Women’s Hospital, and assistant professor of medicine at Harvard Medical School in Boston

As the panel wrapped up the discussion on anticoagulation for the day, the panelists each offered their final parting thoughts on the topic. Bilazarian said that he tells his patients that if he were the one who had to choose, he would prefer to use novel oral anticoagulants over warfarin, because, while there are still some impediments to their widespread use, they have filled a niche with their safety, efficacy, and convenience. Katz emphasized the fact that patients with atrial fibrillation should be on an anticoagulant and not on aspirin. Naccarelli stressed the importance of using real anticoagulants for patients who need them, and said that the package inserts of the novel agents are a great guide to their proper use. For Ruff, the most important point is for physicians to write a prescription for something. In terms of the novel agents, he said that having concrete, practical instructions for their use, as well as the future availability of reversal agents, may help people feel more comfortable with using them.