Interactive Publication Overview

The subject of this interactive, random-access, Web-formatted slide-based publication in The American Journal of Medicine is the welcome addition of highly effective new options in an important area of medicine: anticoagulant prophylaxis. As readers of this Journal will know, systemic thromboembolism represents a life-threatening condition and virtually all physicians and most healthcare providers should be aware of and able to respond to a patient at risk for or presenting with this condition. For decades the only applicable prophylaxis or treatment for this condition has been vitamin K antagonism (VKA), ie, warfarin. Warfarin is an proven and effective anticoagulant. However physicians will also be well aware of the many challenges with this agent: a narrow therapeutic index, many drug-drug and drug-food interactions, patient acceptance and adherence, etc. And yet especially for patients with atrial fibrillation (or other embolic risk factors), anticoagulation is absolutely indicated for protection against stroke and pulmonary embolism. Therefore it is of interest and importance that the last 3 years have seen the introduction of 2 new classes and several new approvals of anticoagulant agents; the challenge is that this represents an embarrassment of riches, for now physicians have several options (including the still-effective warfarin) to discuss with their patients. What are the data, what is the experience, what might be the recommendations? In this interactive publication from the Editors of AJM two leading authorities (Deepak Bhatt, MD, and Elaine Hylek, MD) present brief figure-based overviews of the data and the clinical picture, respectively, joined by two additional authorities (Michael Jaff, DO, and John Fanikos, PharmD) for a Journal-based random-access Roundtable video discussion of the evidence-based results and clinical experience with all of the recently approved agents.

Learning objectives:

Upon reading and interacting with this publication, readers should be able to:

• describe the signs and symptoms of thrombotic risks and events
• review the most advanced treatment options for patients indicated for anticoagulation therapy
• appreciate the similarities and differences among the various therapeutic options for this condition

Target audience:

Physicians and clinicians who see patients at risk for systemic embolic events and who need to read and hear an educated discussion of the most advanced evidence-based strategies for treating these risks and conditions.

Author Affiliations and Financial Disclosures:

The authors are solely responsible for the content of this publication and make the following financial disclosures:

	Deepak L. Bhatt, MD, MPH Interventional Cardiovascular Programs, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA 02115 Dr. Deepak L. Bhatt discloses the following relationships Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda.  Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), WebMD (CME steering committees) Dr Bhatt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr Bhatt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
	Elaine Hylek, MD, MPH Boston University School of Medicine, Boston, Massachusetts Dr Hylek discloses the following relationships relevant to this publication: Advisory Boards: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, Pfizer. Research Grants: Bristol-Myers Squib, Janssen. Honoraria: Boehringer Ingelheim, Bristol-Myers Squibb. Dr. Hylek does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr. Hylek does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
	Michael R. Jaff, DO Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts. Dr Jaff discloses the following relationships relevant to this publication: Ownership Interest/Partnership/Principal: Embolitech, Hotspur, Icon International, Janacare, MC10, Northwind, PQ Bypass, Primacea, Sadra Medical, SanoV, IC sciences (stock options), VIVA Physicians Group (officer). Research Grants: Ekos Honoraria: Abbott Vascular, Access Closure, American Genomics, AstraZeneca, Biomet Biologics, Cordis, Covidien, Micell, Medtronic Vascular, Vacular Therapies. Dr Jaff does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr Jaff does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
	John R. Fanikos, RPh, MBA Brigham and Women's Hospital, Northeastern University. and Massachusetts College of Pharmacy, Boston Massachusetts. Dr Fanikos discloses the following relationships relevant to this publication: Honoraria: Abbott Laboratories, Bayer, Bristol-Myers Squibb, Eisai, Genentech, GlaxoSmithKline, Sanofi, The Medicines Company, Schering. Dr Fanikos does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr Fanikos does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
	All additional planning committee members have no financial relationships to disclose.

Statement of Peer Review

This multimedia publication was reviewed and approved for publication by the editorial office of The American Journal of Medicine.

Disclaimer Statement

The opinions or views expressed on this publication are those of the authors and do not necessarily reflect the opinions and recommendations of the publisher or supporters. Articles may discuss pharmaceutical products and/or use of products that have not been approved by the US Food and Drug Administration or other regulatory authorities outside the United States. Dosages, indication, and methods of use for compounds that are referred to by the presenters/authors may reflect their clinical experience or may be derived from the professional literature or other sources. For approved product information, consult the manufacturer's prescribing information or the applicable regulatory authority.