Anticoagulation management is a rapidly evolving field, bringing challenges to clinicians across a broad range of specialties, including primary care and internal medicine, emergency physicians, hematologists, neurologists, surgeons, electrophysiologists, pharmacists, physician assistants, nurse practitioners, and the list continues.

In view of the timeliness of this topic, the ACC recently held its fifth Anticoagulation Consortium Roundtable focusing on the intersection of anticoagulation with antiplatelet therapy. ACC Science and Quality Committee Chair, Richard J. Kovacs, MD, FACC, kicked off the meeting. “This Roundtable draws on the collective experience and wisdom of our participants to address the common challenges we all face in the intersection of diseases, and in atrial fibrillation (AFib) patients with comorbidities like chronic kidney disease and valve disease,” said Kovacs. “We may not reach consensus; but we aim to uncover the major challenges faced by clinicians in each participant’s specialty area, and we hope to explore ideas of how the ACC can better serve those clinicians.”

In reaction to recent and anticipated large trial results on the topic, Roundtable participants examined the latest evidence and studies and discussed ways these results can and should inform future ACC initiatives, clinical documents and tools. Several recently created apps and tools were highlighted, including the DAPT Risk Calculator.

The Roundtable also provided a forum to address controversies and unmet needs in anticoagulation management in valvular AFib and chronic kidney disease. Mintu Turakhia, MD, MS, FACC, talked about the complex relationship between AFib and kidney disease, how each increases risk of the other, while both increase risk of ischemic stroke. “We have enough data to be worried, but not enough data to be sure,” said Turakhia. Additionally, the perception of risk, threshold for treatment, and disparities in care associated with gender and race were also explored. Stacie L. Daugherty, MD, MSPH, FACC, showed that race and ethnic minorities, as well as women, receive less oral anticoagulants (OAC) at all levels of risk. Daugherty concluded that interventions aimed at increasing appropriate OAC use, particularly for this population segments, are needed.

According to Roundtable Chair Andrea Russo, MD, FACC, the discussions and multidisciplinary insights coming out of the Roundtable will be used to inform outputs and further develop resources.

This Roundtable is part of the Heart House Roundtable Series that started in September 2013 with the first Anticoagulation Consortium Roundtable held every year since. The Roundtables explore practical issues that clinicians face every day in high-value clinical areas, and gather a diverse group of clinical experts representing a wide variety of professional societies relevant to a specific topic, as well as other key stakeholders. This diversity of expertise is what makes the Roundtables successful in providing a valuable forum for interactive and facilitated discussion on important clinical topics. Visit ACC.org/Anticoagulation for more information on this topic.

The 2017 Anticoagulation Consortium Roundtable was supported by Bristol-Myers Squibb Company and Pfizer Inc.; Janssen Pharmaceuticals, Inc.; and Portola Pharmaceuticals, Inc.

Keywords: Anticoagulants, Atrial Fibrillation, Stroke, Minority Groups, Internal Medicine

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