Welcome to the Emergency Medicine Cases Podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

Back in 2013 on episode 37 anticoagulants PCCs and platelets, we introduced the then-cutting-edge NOACs, new oral anticoagulants.

But there's been a truckload of research and experience with these drugs since then.

So fast forward to late 2016, and we no longer call them NOACs, because they're not new anymore,

but rather DOACs. Direct, oral anticoagulants. So here they are. Ready?

Debigatran, brand name Prodaxa, Rivaroxan, brand name Zarelto, Apixaban, brand name Elyquist,

and the newest kid on the block, Adoxaban, which isn't yet available in Canada.

Well, what else has changed in 2016?

Well, in general, we're seeing way more patients taking anticoagulants as we're getting better at picking up thrombolic disease, and the indications for these drugs are widening.

As well, management decisions have become a whole lot more complicated with all these anticoagulation

options. We've also got a couple of new reversal agents that we need to

know about. So there's a lot that we need to know about these drugs to minimize the risk of thromboambulism

in our patients while at the same time minimizing their risk of bleeding. You know, pretty much every shift I

work, I'm faced with a clinical dilemma related to anticoagulants and thrombosis or else bleeding.

We're dealing with this all the time.

We need to know when we can stop these meds safely, how to manage bleeding on these meds, and when to call for help.

So with these goals in mind, we've got three truly expert guests on the podcast with us,

and I anticipate that they'll have slightly different points of view.

We've got the mighty return of my friend and colleague,

the walking encyclopedia of EM, Dr. Walter Himmel,

who's been lecturing extensively on DOACs over the last few years,

...