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New Oral Anticoagulants Markets - Product Image

New Oral Anticoagulants Markets

  • Published: March 2013
  • Region: Global
  • 246 Pages
  • TriMark Publications

FEATURED COMPANIES

  • 1 Varespladib/A-002
  • AstraZeneca, PLC
  • Eisai Co., Ltd.
  • Genentech, Inc.
  • Medicure, Inc.
  • Rivaroxaban (Xarelto)
  • MORE

Anticoagulants decrease the ability of the blood to create harmful blood clots that can ultimately leading to a heart attack or stroke. Although sometimes referred to as blood thinners, they do not actually thin the blood and only help prevent the formation of new blood clots. For more than 50 years and until recently, the only oral anticoagulants were vitamin K antagonists such as warfarin. Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban) and other new oral anticoagulants have several advantages over warfarin, including no periodical laboratory monitoring and more predictable effects with fixed doses.

This TriMark Publications report provides a thorough overview of these and other new oral anticoagulants, their approved indications, drug profiles, pharmacokinetic parameters and the respective areas of market growth. The study also analyzes almost all of the companies known to be marketing, manufacturing or developing oral anticoagulant products in the U.S. and worldwide. Detailed tables and charts with sales forecasts and marketshare data are also included.

1. Introduction
1.1 Scope of this Report
1.2 Methodology
1.3 Executive Summary

2. An Overview of Anticoagulants
2.1 Scope of this Chapter
2.1.1 Unmet Medical Needs with Existing Anticoagulants
2.1.2 Pharmacology of Injectable Anticoagulants
2.1.3 Marketed and Registered Drugs for Anticoagulation and Related Disorders
2.2 Oral Anticoagulants
2.2.1 Potential Limitations of New Oral Anticoagulants
2.2.2 Desired Attributes of Anticoagulants
2.2.3 Comparison of New Anticoagulants
2.2.4 Bleed Rates of New Anticoagulants

3. Selected Oral Anticoagulants
3.1 Warfarin
3.1.1 Warfarin's Place in Clinical Therapy
3.1.2 Drug Interaction with Warfarin
3.1.3 Warfarin's Interactions with Food
3.1.4 Interactions of Warfarin with Dietary Vitamin K
3.2 Dabigatran (Pradaxa)
3.2.1 Use of Dabigatran in Particular Situations
3.2.2 Measuring the Anticoagulant Effect of Dabigatran
3.2.3 Activated Partial Thromboplastin Time (aPTT)
3.2.4 Thrombin Time (TT) and Hemoclot
3.2.5 Ecarin Clotting Time (ECT)
3.2.6 Prothrombin Time (PT) and INR
3.2.7 Measures for Overdose
3.2.8 Management of Bleeding Complications
3.2.9 For Patients Undergoing Surgical Intervention
3.2.10 For Dental Interventions
3.2.11 For Spinal Anesthesia/Epidural Anesthesia/Lumbar Puncture
3.2.12 For Patients with Acute Coronary Syndrome (ACS)
3.2.13 Cardioversion in Dabigatran Treated Patients
3.2.14 For Patients with Stroke
3.2.15 Dabigatran after Ischemic Stroke
3.2.16 Strengths and Weaknesses of Dabigatran
3.2.16.1 Strengths of Dabigatran in Metabolism, Pharmacokinetics and Pharmacodynamics
3.2.16.2 Weaknesses of Dabigatran in Metabolism, Pharmacokinetics and Pharmacodynamics
3.2.16.3 Strengths of Dabigatran in Laboratory Monitoring
3.2.16.4 Weaknesses of Dabigatran in Laboratory Monitoring
3.2.16.5 Strengths of Dabigatran in Clinical Efficacy
3.2.16.6 Weaknesses of Dabigatran in Clinical Efficacy
3.2.16.7 Strengths of Dabigatran in Controlling Bleeding
3.2.17 Comparison of Dabigatran and Rivaroxaban in Sites of Action
3.3 Rivaroxaban (Xarelto)
3.3.1 Dosage and Administration
3.3.2 Risk of Stroke after Discontinuation in Non-Valvular Atrial Fibrillation
3.3.3 Risk of Bleeding
3.3.4 Bleeding Events in ROCKET AF Trial
3.3.5 Bleeding Events in RECORD Trial
3.3.6 Overdosage
3.3.7 Mechanism of Action
3.3.8 Comparable Efficacy of Rivaroxaban
3.3.9 Prophylaxis of Deep Vein Thrombosis
3.4 Eliquis (Apixaban)
3.4.1 AVERROES Results
3.5 Edoxaban
3.6 Betrixaban
3.7 Pipeline Agents
3.8 Comparison of Oral Anticoagulants
3.9 Heparins
3.10 Dalteparin (Fragmin)
3.11 Enoxaparin (Lovenox)
3.11.1 Indications and Usage
3.11.2 Percutaneous Coronary Revascularization Procedures
3.11.3 Use of Lovenox with Concomitant Medical Conditions
3.11.3.1 Thrombocytopenia
3.11.3.2 Interchangeability with Other Heparins
3.11.3.3 Pregnant Women with Mechanical Prosthetic Heart Valves
3.11.3.4 Laboratory Tests
3.11.3.5 Pharmacodynamics
3.11.3.6 Pharmacokinetics
3.12 Fondaparinux (Arixtra)
3.13 Tinzaparin (Innohep)
3.14 Semuloparin Sodium (AVE5026)
3.15 Idrabiotaparinux
3.16 Otamixaban
3.17 RB006
3.18 Reversal Agents and Antidotes
3.18.1 Vitamin K
3.18.2 Recombinant Factor VIIa
3.18.3 Prothrombin Complex Concentrates

4. A Brief Overview of Antiplatelets
4.1 Overview of this Chapter
4.1.1 Differences between Antiplatelets and Anticoagulants
4.1.2 Need for Antiplatelets
4.1.3 Side Effects of Antiplatelets
4.1.4 Choosing an Antiplatelet
4.1.5 Role of Platelets in Thrombosis
4.1.6 Inhibitors of Platelet Adhesion
4.1.7 Inhibitors of Platelet Activation
4.1.7.1 Inhibitors of TXA2 Pathway
4.1.7.2 Inhibitors of P2Y12
4.1.7.3 PAR-1 Inhibitors
4.1.7.4 Phosphodiesterase Inhibitors
4.2 Antiplatelet Drugs
4.2.1 Aspirin
4.2.2 Aggrenox
4.2.3 Ticagrelor (Brilinta)
4.2.4 Clopidogrel (Plavix)
4.2.4.1 Indications and Usage
4.2.4.2 General Risk of Bleeding
4.2.5 Effient (Prasugrel)

5. Coagulation Assays
5.1 Clotting Assays
5.1.1 Chromogenic Methods
5.1.2 Prothrombin Time
5.1.3 Activated Partial Thromboplastin Time
5.1.4 Thrombin Time
5.1.5 Fibrinogen (Clauss Method)
5.1.6 Derived Fibrinogen
5.1.7 Antithrombin
5.1.8 Protein C
5.1.9 Protein S
5.1.10 Lupus Anticoagulants
5.1.11 ProC Global Assay and APC Resistance (APCR)
5.2 Influence of New Anticoagulants on Coagulation Assays

6. Disease Conditions Targeted by Anticoagulants
6.1 Cardiovascular Diseases
6.1.1 Stroke
6.1.2 Ischemic Stroke
6.1.3 Hemorragic Stroke
6.1.4 Subarachnoid Hemorrage
6.1.5 Global Incidence and Prevalence of Stroke
6.1.6 Incidence of Stroke in the U.S.
6.1.7 Mortality from Heart Disease and Stroke in Selected OECD Countries
6.1.8 Anticoagulants Used in the Treatment for Stroke
6.1.8.1 Heparin
6.1.8.2 Warfarin
6.1.9 Antiplatelets
6.1.9.1 Aspirin
6.1.9.2 Dipyridamole
6.1.9.3 Clopidogrel
6.1.10 Transient Ischemic Attack (Mini Stroke)
6.1.10.1 Drug Therapy for Mini Stroke
6.1.11 Market for Stroke Medication
6.2 Cardiac Arrhythmia
6.2.1 Tachycardias
6.2.2 Bradycardias
6.2.3 Medications for Arrhythmias
6.2.4 Anticoagulants Used to Treat Arrhythmias
6.2.5 Global Market for Atrial Fibrillation Drugs
6.2.6 Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation
6.2.7 Clinical Data on Direct Thrombin Inhibitors
6.2.7.1 Dabigatran
6.2.7.2 Clinical Data on Oral Factor Xa Inhibitors
6.2.8 Rivaroxaban
6.2.9 Apixaban
6.2.10 Betrixaban
6.2.11 Edoxaban
6.3 Coronary Artery Disease
6.3.1 Global CAD Therapeutics Market
6.3.2 Anticoagulation in Acute Coronary Syndrome
6.3.3 Antiplatelet Therapy
6.3.4 Antricoagulants Therapy
6.4 Heart Attack (Myocardial Infarction)
6.4.1 Global Market for CHF Pharmaceuticals
6.4.2 Declining Trend in the U.S. Heart Attack Rates
6.4.3 Cost of Cardiovascular Diseases
6.5 Heart Valve Replacement
6.5.1 Market Trends in Prosthetic Heart Valves
6.5.2 Market for Mechanical Heart Valves
6.5.3 Market for Tissue Heart Valves
6.5.4 Heart Valve Replacement and Anticoagulants
6.5.4.1 Anticoagulation Therapy in Patients with Prosthetic Heart Valves
6.6 Deep Vein Thrombosis (DVT)
6.6.1 Commonly Recognized Signs and Symptoms of DVT
6.6.2 Complications of VTE
6.6.3 Use of Risk Assessment Tools in the Diagnosis of DVT
6.6.4 Current Anticoagulants Treatment Modalities for DVT
6.6.5 Use of Xarelto
6.6.6 Use of Enoxaparin: Inpatient and Outpatient
6.6.7 Use of Fondaparinux: Inpatient
6.6.8 Prophylactic Interventions
6.7 Joint Replacement Surgery and Risk of Blood Clot Formation
6.7.1 Joint Replacement Surgeries in the U.S.
6.7.2 Hip and Knee Replacement Surgeries in OECD Countries
6.7.3 Global Orthopedic Industry
6.7.4 Hip Replacement
6.7.4.1 U.S. Market for Hip Replacement
6.7.5 Knee Replacement
6.7.5.1 U.S. Knee Replacement Market
6.7.6 Shoulder Replacement
6.7.6.1 Global Shoulder Replacement Market
6.7.7 Oral Thrombophylaxis Following Total Hip and Knee Replacement
6.7.7.1 Thrombophylactic Agents
6.7.7.2 Reasons for Increased Clot Risk after Surgery
6.8 Prophylactic Anticoagulation after a Hip Fracture
6.8.1 Pharmacologic Prevention of Blood Clots after a Hip Fracture
6.8.1.1 Aspirin
6.8.1.2 Warfarin
6.8.1.3 Heparins
6.8.1.4 Fondaparinux
6.8.2 Duration of Prophylaxis after Hip Fracture
6.9 Pulmonary Embolism (Blood Clot in the Lung)
6.9.1 Signs and Symptoms of Pulmonary Embolism
6.9.2 Anticoagulation Therapy for Pulmonary Embolism
6.10 Oral Surgery and Anticoagulation Therapy
6.10.1 Required Laboratory Investigations for Dental Patients on Anticoagulation
6.11 Hemodialysis
6.11.1 Global Market for Hemodialysis
6.11.2 Global Operators of Dialysis Clinics
6.11.3 Global Leaders in Hemodialysis Products
6.11.4 Global Leaders in Peritoneal Dialysis Products
6.11.5 Anticoagulation in Hemodialysis
6.12 Cancer
6.12.1 Global Market for Cancer Therapeutics
6.12.2 The Cancer-Thrombosis Connection

7. Market Analysis: Anticoagulants
7.1 Overview of this Chapter
7.2 Oral Anticoagulants
7.2.1 Vitamin K Antagonists
7.2.1.1 Global Market for Warfarin
7.2.1.2 The Threatened Position of Warfarin in the Anticoagulants Market
7.2.1.3 Newer Oral Anticoagulants to Replace Warfarin
7.2.1.4 Potential Alternatives to Warfarin
7.2.2 Factor Xa Inhibitors
7.2.2.1 Global Market for Factor Xa Inhibitors
7.2.3 Global Market for Xarelto (Rivaroxaban)
7.2.3.1 Xarelto: A Great Promise
7.2.3.2 U.S. Market for Xarelto
7.2.3.3 U.S. Market Share for Eliquis, Xarelto and Pradaxa
7.2.4 Direct Thrombin Inhibitors (DTI)
7.2.4.1 Global Market for Direct Thrombin Inhibitors
7.2.5 Global Market for Pradaxa (Dabigatran)
7.2.5.1 Dawning of the Age of Dabigatran
7.2.5.2 Pradaxa: Bringing Potential Sea Change in AF
7.2.5.3 Dabigatran?s First Year in the Market
7.3 Parenteral Anticoagulants
7.3.1 Pharmacology of Parenteral Anticoagulants
7.3.2 Adverse Effects of Parenteral Anticoagulants
7.3.3 Parenteral Thrombin Inhibitors
7.3.3.1 Parenteral Indirect Thrombin Inhibitors
7.3.3.2 Market for Unfractionated Heparin (UFH)
7.3.3.3 Market for Low Molecular Weight Heparin (LMWH)
7.3.3.4 Distribution of LMWH Sales per Indication
7.3.4 Global Market for Lovenox
7.3.4.1 Lovenox: The Broadest Label
7.3.5 Pentasaccharide Anticogulants
7.3.5.1 Fondaparinux (Arixtra)
7.3.5.2 Arixtra: A Missed Opportunity
7.3.6 Parenteral Direct Thrombin Inhibitors
7.3.6.1 Bivalirudin (Angiomax)
7.4 Market for Venous Thromboembolic Drugs
7.5 Market for Direct Thrombin Inhibitors
7.6 Comparisons of Market Opportunities for Anti-Thrombotic Agents
7.7 Global Market for Anticoagulants
7.7.1 Market Share of Anticoagulants by Type
7.8 U.S. Market for Anticoagulants
7.9 More Anticoagulants in Pipeline

8. Market for Antiplatelets
8.1 Overview of this Chapter
8.2 The Threatened Market of Plavix
8.2.1 Patent Loss of Plavix
8.2.2 Patent Loss of Plavix and Competitive Advantages for New Entrants
8.3 Market for Effient (Prasugrel)
8.3.1 Slow Uptake of Effient
8.4 Market for Pletal (Cilostazol)
8.5 Market for Activase (Alteplase)
8.6 Market for Aggrenox
8.7 Market for CardioAspirin
8.8 Market for Opalmon
8.9 Market for Integrilin (Eptifibatide)
8.10 Market for ReoPro (Abciximab)
8.11 Market for Brilinta
8.12 Market for Diagnostic Assays of Platelet Function
8.13 The Anti-Platelet Pipeline

9. Deals in Anti-Thrombotic Therapeutics Sector
9.1 Sanofi?s Extensive Anti-Thrombotic Partnering Landscape
9.2 Daiichi Sankyo?s Licensing Portfolio
9.3 Merck & Co. Agreements for Arterial Thrombotic Therapeutics
9.4 Deals between Bristol-Myer?s Squibb and Pfizer
9.5 Partnership between Ortho-McNeil and Bayer for Xarelto

10. Utilization of Anticoagulants and Antiplatelets in the U.S.
10.1 Anti-Thrombotic Drugs Used in Asia-Pacific Countries
10.2 Antiplatelets Used in Asia-Pacific for Stroke Prevention
10.3 Antithrombotic Strategy According to CHADS2
10.4 Antithrombotic Strategy for Patients with No Risk Factors (CHADS2=0)
10.5 Antithrombotic Strategy for Patients with 1 Risk Factor (CHADS2=1)
10.6 Antithrombotic Strategy for Patients with (CHADS2=2) Score 2
10.7 Adjustment of INR According to Age
10.8 Antithrombotic Treatment for Paroxysmal vs. Persistent AF
10.9 Oral Anticoagulation during Tooth Extraction
10.10 Oral Anticoagulation during Endoscopy or General Surgery
10.11 Oral Anticoagulation during Cardioversion for Persistent AF and Paroxysmal AF
10.12 Awareness Levels about New Anticoagulants
10.13 Reasons for Prescribing Dabigatran

11. Selected Company Profiles
11.1 Akers Biosciences, Inc.
11.1.1 PIFA Heparin/Platelet Factor 4 Rapid Assay
11.2 Anthera Pharmaceuticals, Inc.
11.2.1 Varespladib/A-002
11.3 ARYx Therapeutics, Inc.
11.3.1 Tecarfarin
11.3.2 Tecarfarin Development Status
11.4 AstraZeneca, PLC
11.4.1 Brilinta (Ticagrelor)
11.5 Boehringer Ingelheim GmbH
11.5.1 Boehringer?s Dedication to Innovation
11.5.2 Boehringer?s Therapeutic Breakthrough
11.5.3 Registration Study RE-LY
11.6 Cipla Limited
11.7 Daiichi Sankyo Company Ltd.
11.7.1 LIXIANA
11.8 Eisai Co., Ltd.
11.8.1 Fragmin
11.9 Eli Lilly & Co
11.9.1 Effient (Daiichi Sankyo)
11.9.2 General Risk of Bleeding
11.9.3 Coronary Artery By-Pass Graft Surgery-Related Bleeding
11.9.4 Discontinuation of Effient
11.9.5 Thrombotic Thrombocytopenic Purpura
11.9.6 Hypersensitivity Including Angiodema
11.9.7 Clinical Studies
11.10 Genentech, Inc.
11.10.1 Activase (Altepase)
11.11 GlaxoSmithKline PLC
11.11.1 Fondaparinux
11.12 Medicure, Inc.
11.12.1 Aggrastat
11.13 Merck & Co., Inc.
11.13.1 SCH 5303348
11.14 Novartis AG
11.14.1 Elinogrel
11.15 Ortho-McNeil Pharmaceutical, Inc.
11.15.1 Rivaroxaban (Xarelto)
11.16 Pfizer, Inc.
11.16.1 Eliquis (Apixaban)
11.17 Pharmion, LLC
11.17.1 Tinzaparin (Innohep)
11.18 Portola Pharmaceuticals, Inc.
11.19 Sanofi
11.19.1 Lovenox (Enoxaparin)
11.19.2 Idrabiotaparinux
11.20 The Medicines Company
11.20.1 Argatroban
11.20.2 Angiomax (Bivalirudin)

Appendix 1: Innovations in Cardiac Rhythm Management with New Anticoagulants
Appendix 1.1: Dual Antiplatelet Therapy
Appendix 1.2: Direct Thrombin Inhibitors
Appendix 1.3: Factor Xa Inhibitors
Appendix 1.4: Comparing the Trials
Appendix 1.5: Interventions Targeting the Left Atrial Appendage
Appendix 2: Oral Contraceptives and the Risk of Venous Thromboembolism
Appendix 2.1: Hormonal Effects on Venus Thromboembolism
Appendix 2.2: Assessing Venous Thromboembolism Risks of Oral Contraceptives
Appendix 2.3: Recent Research

INDEX OF FIGURES

Figure 2.1: Almost 100 Years of Anticoagulation Therapy
Figure 2.2: Site of Action of New Anticoagulants
Figure 3.1: Pathway of Dabigatran Action
Figure 3.2: Sites of Action of Dabigatran and Rivaroxaban
Figure 3.3: Time to First Occurrence of Stroke by Treatment Group
Figure 3.4: Apixaban in Patients with Atrial Fibrillation
Figure 3.5: Management of Bleeding Complications (For all Oral Anticoagulants)
Figure 3.6: Blood Coagulation System Context for Heparin Anticoagulant Action
Figure 4.1: Role of Platelets in Thrombosis
Figure 4.2: Sites of Actions of Antiplatelets
Figure 6.1: Global Incidence and Prevalence of Stroke
Figure 6.2: U.S. Hospitalization Rates for Stroke for those Aged 65 and Over, 1989-2009
Figure 6.3: Mortality Rates for Ischemic Heart Disease in Selected OECD Countries, 2009
Figure 6.4: Global Market for Stroke Medications, 2012-2019
Figure 6.5: Global Market for Atrial Fibrillation Drugs, 2012-2019
Figure 6.6: Coagulation Cascade
Figure 6.7: Cumulative Hazard Rates for the Primary Endpoint in the RE-LY Trial
Figure 6.8: Percentage of Cumulative Hazard Rates for the Primary Endpoint in the RE-LY Trial
Figure 6.9: All-Cause Mortality in the RE-LY Trial
Figure 6.10: Global CAD Therapeutics Market, 2012-2019
Figure 6.11: Management of UA/NSTEMI
Figure 6.12: Global Market for CHF Pharmaceuticals, 2012-2019
Figure 6.13: Global Market for Prosthetic Heart Valves, 2012-2019
Figure 6.14: Global Market for Mechanical Heart Valves, 2012-2019
Figure 6.15: Global Market for Tissue Heart Valves, 2012-2019
Figure 6.16: Recommendations from the Seventh ACCP Consensus Conference
Figure 6.17: Algorithm for Antithrombotic Therapy for Prosthetic Heart Valves
Figure 6.18: Phases of VT and Conventional Treatments with Anticoagulants
Figure 6.19: Estimated Increase of THR and TKR in the U.S., 2005-2030
Figure 6.20: Hip Replacement Surgery in OECD Countries, 2009
Figure 6.21: Knee Replacement Surgeries in OECD Countries, 2009
Figure 6.22: U.S. Hip Replacement Market, 2012-2019
Figure 6.23: U.S. Knee Replacement Market, 2012-2019
Figure 6.24: Global Shoulder Replacement Market, 2012-2019
Figure 6.25: Global Market for Hemodialysis, 2012-2019
Figure 6.26: Percent Global Operators of Dialysis Clinics by Country, 2011
Figure 6.27: Global Leaders in Dialysis Products
Figure 6.28: Global Hemodialysis Products Market by Vendor, 2011
Figure 6.29: Global Leaders in Peritoneal Dialysis Products Market, 2011
Figure 6.30: Global Market for Cancer Therapeutics, 2012-2019
Figure 7.1: Estimated Global Market for Coagulation Testing, 2012-2019
Figure 7.2: Anticoagulant Market Segments
Figure 7.3: Mechanism of Action of Warfarin
Figure 7.4: Global Market for Warfarin, 2011-2016
Figure 7.5: Global Market for Factor Xa Inhibitors, 2012-2019
Figure 7.6: Global Market for Rivaroxaban, 2012-2019
Figure 7.7: U.S. Market for Xarelto, 2012-2019
Figure 7.8: Estimated U.S. Market Share of New Anticoagulants in 2019
Figure 7.9: Binding Sites of Univalent and Bivalent DTIs
Figure 7.10: Global Market for Direct Thrombin Inhibitors, 2012-2019
Figure 7.11: Global Market for Pradaxa (Dabigatran), 2012-2019
Figure 7.12: Mechanism of Thrombin Inhibition
Figure 7.13: Mechanism of Action of Indirect Thrombin Inhibitors
Figure 7.14: Global Market for Unfractionated Heparin (UFH), 2012-2019
Figure 7.15: Global Market for LMWHs, 2012-2019
Figure 7.16: Distribution of LMWH Sales per Indication
Figure 7.17: Global Market for Lovenox (Enoxaparin), 2012-2019
Figure 7.18: Sales of Arixtra, 2005-2009
Figure 7.19: U.S. Sales of Angiomax, 2001-2010
Figure 7.20: Global Market for Venous Thromboembolic Drugs, 2012-2019
Figure 7.21: Global Market for Direct Thrombin Inhibitors, 2012-2019
Figure 7.22: Overall Global Market for Anticoagulants, 2012-2019
Figure 7.23: Global Market Share of Anticoagulants by Type, 2011
Figure 7.24: U.S. Market for Anticoagulants, 2012-2019
Figure 8.1: Global Market for Antiplatelets, 2012-2019
Figure 8.2: The Declining Market for Plavix, 2012-2015
Figure 8.3: Market for Effient (Prasugrel), 2012-2019
Figure 8.4: Market for Pletal, 2012-2019
Figure 8.5: Market for Activase (Alteplase), 2012-2019
Figure 8.6: Market for Aggrenox, 2012-2019
Figure 8.7: Market for CardioAspirin, 2012-2019
Figure 8.8: Market for Opalmon (Limaprost), 2012-2019
Figure 8.9: Market for Integrilin, 2012-2019
Figure 8.10: Market for ReoPro, 2012-2019
Figure 8.11: Estimated Market for Diagnostic Assays of Platelet Function, 2013-2018
Figure 10.1: Anti-Thrombotics Prescribed for Stroke Prevention in Asia-Pacific, 2012
Figure 10.2: Antiplatelets Prescribed for Stroke Prevention in Asia-Pacific, 2012
Figure 10.3: Antithrombotic Strategy According to CHADS2 Score, 2012
Figure 10.4: Antithrombotic Strategy for Patients with No Risk Factors (CHADS2=0), 2012
Figure 10.5: Antithrombotic Strategy for Patients with 1 Risk Factor (CHADS2=1), 2012
Figure 10.6: Antithrombotic Strategy for Patients with (CADS2=2) Score 2, 2012
Figure 10.7: Adjustment of INR According to Age
Figure 10.8: Antithrombotic Treatment for Paroxysmal vs. Persistent AF
Figure 10.9: Oral Anticoagulation during Tooth Extraction
Figure 10.10: Oral Anticoagulation during Endoscopy or General Surgery
Figure 10.11: Oral Anticoagulation during Cardioversion for Persistent AF
Figure 10.12: Awareness Levels about New Anticoagulants
Figure 10.13: Awareness about Dabigatran
Figure 10.14: Top Three Reasons for Prescribing Dabigatran in Place of Warfarin
Figure 11.1: Boehringer?s Pipeline (84 Products in Development)
Figure 11.2: The 3D Structure of Dabigatran in Complex with Thrombin
Figure 11.3: Non-CABC-Related TIMI Major or Minor Bleeding Events
Figure 11.4: Time to First Event of CV Death, MI or Stroke (TRITON-TIMI 38)
Figure A1.1: Transesophageal Echocardiogram Showing Thrombus in the Left Atrial Appendage

INDEX OF TABLES

Table 2.1: Limitations and Consequences of Vitamin K Antagonists
Table 2.2: Pharmacokinetics of Injectable Anticoagulants
Table 2.3: Marketed and Registered Drugs for Anticoagulation and Related Disorders
Table 2.4: Desired Attributes of Newly Developed Anticoagulants
Table 2.5: Comparison of New Anticoagulants
Table 3.1: Examples of Drugs that Interact with Warfarin
Table 3.2: Vitamin K Content of Selected Vegetables
Table 3.3: Weekly Requirements of Vegetables Based on Age and Gender
Table 3.4: Vitamin K Content of Commonly Used Oils
Table 3.5: Vitamin K Content in the Oil of Fast and Processed Foods
Table 3.6: Vitamin K Content in Nutritional Supplements per 8 OZ
Table 3.7: Mean Dabigatran Plasma Concentration and the 25th-75th Percentiles
Table 3.8: Discontinuation Rules before Surgical Procedures
Table 3.9: Strengths and Weaknesses of Dabigatran Compared with Others
Table 3.10: Bleeding Events in ROCKET AF Trial
Table 3.11: Bleeding Events in Patients Undergoing Hip or Knee Replacement Surgeries (RECORD)
Table 3.12: Other Adverse Reactions Reported in RECORD 1-3 Studies
Table 3.13: Clinical Outcomes of EINSTEIN PE
Table 3.14: Primary Composite Endpoint Results in ROCKET AF Study
Table 3.15: Key Efficacy Analysis Results from RECORD Trial
Table 3.16: Phase III AF Trials
Table 3.17: Drugs in Development for Anticoagulation and Related Disorders
Table 3.18: Comparison of Oral Anticoagulants
Table 3.19: Pharmacokinetic Parameters after Five Days of 1.5 mg/kg SC Once Daily Doses of Enoxaparin Sodium Using 100 mg/mL or 200 mg/mL Concentrations
Table 3.20: Pharmacokinetic Parameters of Fondaparinux and Other Anticoagulants
Table 3.21: Composition of 20,000 Anti-Xa IU/mL Innohep
Table 3.22: Comparison of Characteristics of AVE5026, Idrabiotaparinux, Otamixaban and RB006
Table 4.1: Comparison of Top Five Antiplatelets
Table 4.2: Estimated Yearly Incidence of Bleeding with Antiplatelets
Table 4.3: Summary of Evidence for Antiplatelets
Table 4.4: Cost of Antiplatelets
Table 4.5: Information on Ticagrelor
Table 4.6: Product Information on Clopidogrel
Table 4.7: CURE Incidence of Bleeding Complications (% Patients)
Table 4.8: Incidence of Bleeding Event in COMMIT (% Patients)
Table 5.1: Influence of Anticoagulants on Routine Coagulation Assays
Table 5.2: Influence of Anticoagulants on Thrombophilia Assays
Table 6.1: ACC/AHS Recommendations for Antiplatelet Therapy in Patients with NSTEMI or UA
Table 6.2: Dosing of LMWH, Fondaparinux and Bivalirudin in Patients with NSTEMI or UA
Table 6.3: ACC/AHA Recommendations for Anticoagulants Therapy in Patients with NSTEMI or UA
Table 6.4: Antiplatelet Therapy in Patients with STEMI
Table 6.5: Anticoagulants Therapy in Patients with STEMI Who Receive Fibrinolytic Therapy
Table 6.6: Anticoagulants Therapy in Patients with STEMI Who Undergo Primary PCI
Table 6.7: ACCP Recommendations for Thromboprophylactic Strategy Based on Risk for VTE
Table 6.8: Anticoagulants Treatments for VTE
Table 6.9: Projections of Crude Cardiovascular Disease Prevalence, 2010-2030
Table 6.10: Projected Direct Medical Costs for Cardiovascular Diseases, 2010-2030
Table 6.11: Hamilton Score
Table 6.12: Modified Wells Score
Table 6.13: Low Molecular Weight Heparin or Pentasaccharide Indications for VTE Treatment
Table 6.14: Drugs to Prevent Thromboembolism after Hip Fracture
Table 6.15: Complete Blood Count Components
Table 7.1: Oral Anticoagulants Utilization and Cost per Claim
Table 7.2: Oral Anticoagulation Utilization by Age Band, 2011
Table 7.3: Users New to Anticoagulation Therapy and Switch Rate, 2011
Table 7.4: Alternatives to Warfarin
Table 7.5: FDA-Approved Direct Thrombin Inhibitors
Table 7.6: FDA-Approved Parenteral Anticoagulants
Table 7.7: Pharmacokinetics of Parenteral Anticoagulants
Table 7.8: Adverse Effects of Parenteral Anticoagulants
Table 7.9: Available Forms of Parenteral Anticoagulants
Table 7.10: Characteristics of Available LMWH
Table 7.11: Risk Factors for Venous Thromboembolism
Table 7.12: Anti-Thrombotic Agents Market, 2012 and 2019
Table 7.13: Partial List of Anticoagulants in Development
Table 8.1: Comparison of Antiplatelets
Table 8.2: History of Prasugrel
Table 9.1: Selected Sanofi?s Agreements for Antithrombotics
Table 9.2: Selected Daiichi Sankyo?s Agreements for Anti-Thrombotics
Table 9.3: Agreements for Integrilin
Table 9.4: Agreements for Aggrastat
Table 9.5: Notable High-Value Deals for Anti-Thrombotics
Table 11.1: Cipla?s Anticoagulant and Antithrombotic Products
Table 11.2: Dosage and Administration of Fragmin
Table 11.3: Patients with Outcome Events in TRITON-TIMI 38
Table 11.4: Medication Information for Tinzaparin
Table 11.5: Product Pipeline from Portola
Table 11.6: Dosage and Administration of Lovenox
Table A1.1: Risk Factors for Thromboembolism and Latest Guideline Management Recommendations
Table A1.2: Comparison of the Three Studies of New Anticoagulants for Atrial Fibrillation

- 1 Varespladib/A-002
- Activase (Altepase)
- Aggrastat
- Akers Biosciences, Inc.
- Angiomax (Bivalirudin)
- Anthera Pharmaceuticals, Inc.
- Argatroban
- AstraZeneca, PLC
- Boehringer Ingelheim GmbH
- Boehringer's Dedication to Innovation
- Boehringer's Therapeutic Breakthrough
- Brilinta (Ticagrelor)
- Cipla Limited
- Clinical Studies
- Coronary Artery By-Pass Graft Surgery-Related Bleeding
- Daiichi Sankyo Company Ltd.
- Discontinuation of Effient
- Effient (Daiichi Sankyo)
- Eisai Co., Ltd.
- Eli Lilly & Co
- Elinogrel
- Eliquis (Apixaban)
- Fondaparinux
- Fragmin
- Genentech, Inc.
- General Risk of Bleeding
- GlaxoSmithKline PLC
- Hypersensitivity Including Angiodema
- Idrabiotaparinux
- LIXIANA
- Lovenox (Enoxaparin)
- Medicure, Inc.
- Merck & Co., Inc.
- Novartis AG
- Ortho-McNeil Pharmaceutical, Inc.
- PIFA Heparin/Platelet Factor 4 Rapid Assay
- Pfizer, Inc.
- Pharmion, LLC
- Portola Pharmaceuticals, Inc.
- RYx Therapeutics, Inc.
- Registration Study RE-LY
- Rivaroxaban (Xarelto)
- SCH 5303348
- Sanofi
- Tecarfarin
- Tecarfarin Development Status
- The Medicines Company
- Thrombotic Thrombocytopenic Purpura
- Tinzaparin (Innohep)

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