Presentation Outline ICHP Annual Meeting September 13-15

Reasons for Discontinuation
• Gastrointestinal Side Effects
– Diarrhea
– Heartburn
– Upset stomach
• Off‐label Indications
– DVT prophylaxis and aortic stenosis
• Clot Formation
– Patient admitted with a PE
Comparison of Results
RE‐LY Study Current Study
• Overall rate of
discontinuation: 15.5%
– Discontinuation due to
gastrointestinal symptoms
• 130 patients (2.1%)
Evaluation
• Total number of Lutheran
Medical Group patients
prescribed dabigatran: 66
– Rt Rate of f discontinuation di ti ti for f
the current study: 25%
– Discontinuation due to
gastrointestinal symptoms
• 3 patients (14%)
Connolly SJ, Ezekowitz MD, et al. N Engl J Med 2009; 361:1139‐51
• Limitations
– Small sample size
– We do not have a baseline value to compare our
data to because we do not know the percentage
of patients currently on warfarin, who were
initially on dabigatran
Cost Comparison
Dabigatran
Warfarin
• Cash price for 150 mg BID • Anticoagulation Clinic visit
30 day supply at certain
– Visit: $68.48
pharmacies
– Finger stick: $8.55
– $266.32 • Cash price for warfarin 30‐
day supply at certain
pharmacies
– $4
Evaluation
• Benefits
– Results provided an opportunity for pharmacists
to educate prescribers about dabigatran and what
to consider prior p to initiating g therapy py
• Ex: Evaluate the patient’s age and past medical history
before prescribing dabigatran
– Adverse events were identified that can be
reported
Conclusion
• Considerations for dabigatran initiation
– Cost, age, renal function, and a patient’s
willingness to handle gastrointestinal side effects
need to be taken into account
8/29/2012
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