This post was authored by Kim Williams, Sr., MD, FACC, president-elect of the ACC.

Over the years the use of anticoagulants have become a vital means of treating atrial fibrillation, atrial flutter, acute coronary syndromes, ischemic stroke, pulmonary embolism and venous thrombosis. Managing the layered facets of their use, however, can at times be quite daunting for the patients, physicians, nurses, pharmacists and any other stakeholders involved.

In an effort to continue much needed discussions about anticoagulation therapy, including key questions facing providers, patient barriers and evolving research and treatment options, the ACC brought together a number of stakeholders across the health care spectrum for its 2nd Anticoagulation Consortium Roundtable on Saturday, Sept. 27.

Stuart Connolly, MD, FACC, of McMaster University, kicked-off the roundtable with a discussion-provoking talk about how to optimize the net benefit of anticoagulation therapy – specifically, how much bleeding can be tolerated. Connolly asked the question, “How do we balance the risk of stroke and bleeding?” He then discussed the research surrounding the consequences of bleeding and the data surrounding the effects that bleeding has on outcomes. “There has been a lot of research,” Connolly said, “We can come up with any view we want on it but we have to recognize that others have views on it, too.”

The remainder of the day’s agenda was broken into four unique sessions. They first assessed a number of major questions facing providers, including the aspects of bridging and antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention. Robust discussion followed about how most institutions don’t have a uniform way to track bleeding; however, it was noted that a fear of bleeding is one of the top reasons that patients are not anticoagulated.

The following session examined the ever-evolving treatment options of anticoagulation for stroke prevention, focusing on both drug and device-based tactics. Patient barriers were also a significant topic of discussion, with presenters noting the costs of treatment as well as concerns with patient compliance. Through discussion it became apparent that it would be beneficial if anticoagulation clinics integrated with patient home management. The expert panel of stakeholders gathered agreed that only highly motivated patients should be encouraged to do home monitoring and home management. Areas of payor advocacy for patient benefit were also identified, such as improved Medicare coverage of direct acting oral anticoagulants.

Finally, the roundtable ended with discussions about the future of anticoagulation therapy, with a specific focus on current clinical trials. Currently, there are four clinical trials that are reviewing anticoagulation therapy looking at different patient populations. The PIONEEER Study headed up by C. Michael Gibson, MD, FACC, is looking at aspirin discontinuation as is the RE-DUAL PCI Study. Other trials that will help shape anticoagulation therapy moving forward are the EVOLVE-AF study and the Apixaban Study.

ACC has a number of anticoagulation resources, including the Anticoagulation Initiative, the Anticoagulation Management Clinical Community, the AnticoagEvaluator Mobile App and the PINNACLE Registry. The PINNACLE Registry has expanded its focus in atrial fibrillation and includes the latest anticoagulants as a means to monitor practice pattern changes over time and help providers evaluate and improve adherence to established guidelines and performance measures.

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