Perspectives: Patient Management

Peter R. Kowey

Peter R. Kowey

MD, FACC, FACP, FACCP, FHRS

  • Professor of Medicine and Clinical Pharmacology
  • Jefferson Medical College
  • Chief, Division of Cardiovascular Diseases
  • Main Line Health System
  • The William Wikoff Smith Chair in Cardiovascular Research
  • Lankenau Hospital and Medical Research Center
  • Wynnewood, Pennsylvania

PK/PD in anticoagulation

This is an example where the pharmacology of the drugs is extremely important—not just the pharmacokinetics, but also the pharmacodynamics. Obviously the imperative here is to protect patients against their risk of having a stroke, while at the same time not exposing them to an excess risk of having a major bleed. And the only way that can be done is by attempting to achieve optimal plasma concentrations over the dosing period. And that is predicated on the way that the drug is metabolized and eliminated, its bioavailability, and interactions with other drugs.

Age, obviously, is a very important factor here, because organ impairment is more common, but also because the elderly are just much more susceptible to bleed. Renal function is also very important, because many patients with atrial fibrillation are elderly, and age-related decreases in renal clearance are common. Therefore, having reliable data about the appropriate dosing of NOACs in these patients will be an important part of the equation in making a decision in an individual patient.

Welcome to patient management

Welcome to patient management

Oral anticoagulation should consider individual patient differences and needs

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.