Category Archives: Cardiology

Apixaban Should Be the Preferred DOAC for Venous Thromboembolism and Nonvalvular Atrial Fibrillation

In the United States, there are currently four direct oral anticoagulants (DOACs).  All four DOACs are approved for the treatment of venous thromboembolism (VTE) and nonvalvular atrial fibrillation (NVAF), among other indications.1-4  Despite differences in pharmacology, pharmacokinetics, and clinical trial efficacy and safety data, current guidelines do not prefer a specific DOAC.  Given the lack of guideline-based recommendations for a particular DOAC, clinicians are frequently left without clear guidance of the most appropriate DOAC for a particular patient beyond the preferences of an insurance company or the availability of manufacturers’ coupons.  After a careful analysis of the existing data, a very strong case can be made to make apixaban (Eliquis) the preferred DOAC for both VTE and NVAF.

What is the role of DOACs versus warfarin in VTE and NVAF?

For the treatment of venous thromboembolism (VTE), the CHEST 2016 guidelines recommend any of the four DOACs over warfarin therapy for long-term anticoagulation therapy in patients without cancer (grade 2B).5  The guidelines do not specifically endorse any DOAC, although a table is provided that outlines factors that may influence the selection of a “preferred” anticoagulant.  For example, patients wanting to avoid parenteral therapy may prefer rivaroxaban or apixaban because dabigatran and edoxaban require five to ten days of parenteral therapy prior to initiation.

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Visualizing the ACC/AHA ASCVD Pooled Cohort Equations

ASCVD Pooled Cohort Equations Visualization Tool - By Risk Factor

The newest ACC/AHA ASCVD Pooled Cohort Equations has been a very hot topic lately.  Our free web-based ASCVD tool and mobile applications have been very well received.  A number of ClinCalc readers have asked for a better understanding of the Pooled Cohort Equations — how is an ASCVD calculated?  How “strong” is each risk factor?

To help clinicians understand the new Pooled Cohort Equations, we’ve released a fantastic new visualization and graphing tool.  The tool is intended for the advanced clinician who wants to delve deeper into the equations and visualize the tool in a novel, interactive way.

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New Web-Based 10-Year ASCVD Risk Calculator (Pooled Cohort Equations)

ASCVD Calculator for Android and iOS



At ClinCalc, we’re very proud to announce the availability of both a web-based 10-year ASCVD Risk Calculator (also termed the Pooled Cohort Equations Calculator).  This risk assessment tool is recommended by the newly published 2013 ACC/AHA cholesterol guidelines to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD).

WARFASA Trial – Aspirin for VTE Prophylaxis

Mufasa from the Lion King

The WARFASA trial, recently published in the NEJM, examined the role of aspirin after patients with VTE’s had completed 6-18 months of warfarin therapy.  Given the safety of the treatment and the impressive reduction in VTE recurrence, it’s very likely that the results of the  WARFASA trial will find their way into the next CHEST guideline updates. Continue reading