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Supplements and Featured Publications, Healthcare Economics of Effective Anticoagulation, Volume 10, Issue 10 Suppl

The American Journal of Managed Care

This supplement to contains information regarding anticoagulationtherapy, its costs, and the impact underutilization and underdosing has on patients and thehealthcare community. This supplement is based in part on a roundtable meeting held on April 2, 2004,in San Francisco. This supplement has been peer reviewed by an expert in the field.


Ann K. Wittkowsky, PharmD, CACP, FASHP

Clinical Professor

University of Washington School of Pharmacy

Director, Anticoagulation Services

University of Washington Medical Center

Seattle, Washington


Donald Balfour III, MD

President and Medical Director

Sharp Rees-Stealy Medical Group, Inc

San Diego, California

J. Jamie Caro, MDCM


Caro Research

Concord, Massachusetts

Kevin Colgan, RPh, MA

Vice President

Epi-Q, Inc

Oakbrook Terrace, Illinois

Alan S. Go, MD

Physician Scientist

Kaiser Permanente of

Northern California

Oakland, California

Daniel Kus, RPh

Vice President

Ambulatory Pharmacy Services

Clinical Program Manager

Henry Ford Health Systems


Bingham Farms, Michigan

Joseph Menzin, PhD


Boston Health Economics

Waltham, Massachusetts

Thomas Morrow, MD

Vice President and Medical Director

Matria Healthcare

NCQA Surveyor

Alphratta, Georgia

Michael Nelson


Economic & Outcomes Research


Eden Prairie, Minnesota

Gary Rice, RPh, MS

Director of Pharmacy & Retail Services

Kelsey-Seybold Clinic

Houston, Texas

Kenneth L. Schaecher, MD

Medical Director

Utilization Management

Intermountain Healthcare

West Valley City, Utah

Debbie Simonson, PharmD

Manager, Clinical Pharmacy

Ochsner Health Plan

Residency Director

Ochsner Clinic Foundation

New Orleans, Louisiana

Marcus D. Wilson, PharmD

President, Chief Executive Officer


Newark, Delaware

Disclosure Statement

In accordance with the ACCME and the ACPE, participants for this activity have completed a conflict-of-interest disclosure statement.

In compliance with the Health Insurance Portability and Accountability Act standards, no presentationsin this CME/CE activity shall disclose the names or other unique identifiers of patients referencedwithout a signed waiver from the identified patient.

The American Journal of Managed Care

It is the policy of to have all faculty who participate in programssponsored by corporate organizations disclose any real or apparent conflicts of interest.

These participants have declared the following relationships with corporate organizations:

  • J. Jamie Caro, MDCMGrant/Research Support From: AstraZeneca Bristol-Myers Squibb Pharmacia Sanofi
  • Kevin Colgan, RPh, MAGrant/Research Support From: AstraZeneca
  • Ann K. Wittkowsky, PharmD, CACP, FASHPConsultant To: AstraZeneca Aventis
  • Joseph Menzin, PhD Grant/Research Support From: AstraZeneca
  • Thomas Morrow, MDConsultant To: AstraZeneca
  • Michael NelsonGrant/Research Support From: AstraZeneca
  • Gary Rice, RPh, MSGrant/Research Support From: AstraZeneca
  • Debbie Simonson, PharmDSpeakers' Bureau For: Aventis Amgen RocheAdvisory Board For: AstraZeneca Aventis Pfizer
  • Kenneth L. Schaecher, MDConsultant To: AstraZeneca Wyeth
  • Marcus D. Wilson, PharmDResearch/Grant Support From: AstraZeneca

The following participants have declared no financial affiliations with any corporate organizations:

  • Donald Balfour III, MD
  • Alan S. Go, MD
  • Daniel Kus, RPh

The American Journal of Managed Care

Signed disclosures are on file at the offices of , Jamesburg,New Jersey.

NOTE: The Food and Drug Administration (FDA) Cardiovascular & Renal Drugs Advisory Committee votedagainst recommending approval for ximelagatran (Exanta) for all 3 indications under review at the FDA. Theseindications include: prevention of stroke and other thromboembolic complications associated with atrial fibrillation;secondary prevention of venous thromboembolism (VTE) after standard treatment for an acute episode;and short-term prevention of VTE in patients undergoing knee replacement surgery. The committee agreedthat the risk management plan offered by the drug's manufacturer, AstraZeneca, did not seem adequate to preventsevere liver damage. Another concern was the number of adverse cardiac events, such as myocardialinfarction, associated with using ximelagatran for knee replacement surgery. However, these concerns could beaddressed with further safety studies. AstraZeneca is continuing discussions with the FDA and awaits a finaldecision. The FDA committee agreed that ximelagatran demonstrated efficacy in the studies and would be animportant alternative to other older therapies. New drug therapies, including ximelagatran, are discussed inthis supplement.