Top

Published in:

01-05-2014

Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries

Authors: Martin Krejczy, Job Harenberg, Svetlana Marx, Konrad Obermann, Lutz Frölich, Martin Wehling

Published in: Journal of Thrombosis and Thrombolysis | Issue 4/2014

Abstract

We did a cost-utility analysis for the new oral anticoagulants (NOACs) in the German population based on the quality-adjusted life years (QALY), total costs, and incremental cost-effectiveness ratios (ICER). The aim of our investigation was to examine cost-utility for current German drug market costs and compared to other countries. Outcome data were taken from dabigatran’s RE-LY, rivaroxaban’s ROCKET AF, and apixaban’s ARISTOTLE trials. A Markov decision model, the Monte Carlo simulation (MCS), and further sensitivity analyses were used to simulate comparisons between NOACs over a follow up period of 20 years. The main perspective used for the analyses is from a German public health care insurance perspective. The base-case analyses of a 65 years old person with a CHADS2 score >1 resulted in 7.56–7.64 QALYs gained for warfarin. NOACs added 0.04–0.19 QALYs. Total costs for warfarin ranged from 7622 to 9069€ and for NOACs from 19537 to 20048€. The sensitivity analysis indicated that current German market costs for the NOACs exceed a willingness-to-pay threshold of (hypothetical) 50000€/QALY in all treatment regimen. The MCS showed willingness-to-pay thresholds from 60500€/QALY for apixaban to 278000€/QALY for dabigatran 110 mg bid, with values for dabigatran 150 mg bid and rivaroxaban in between. In conclusion, from a German public health care insurance perspective current market costs are high in relation to the quality of life gained. These results from clinical studies (efficacy) remain to be confirmed under real life conditions (effectiveness).

Available only for authorised users

Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22(8):983–988PubMedCrossRef

Hart RG (1999) Warfarin in atrial fibrillation: underused in the elderly, often inappropriately used in the young. Heart 82(5):539–540PubMedCentralPubMed

You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, Hylek EM, Schulman S, Go AS, Hughes M, Spencer FA, Manning WJ, Halperin JL, Lip GY, Physicians ACoC (2012) Antithrombotic therapy for atrial fibrillation: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e531S–e575S. doi:10.1378/chest.11-2304 PubMedCentralPubMed

Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas PE, Widimsky P, Agladze V, Aliot E, Balabanski T, Blomstrom-Lundqvist C, Capucci A, Crijns H, Dahlof B, Folliguet T, Glikson M, Goethals M, Gulba DC, Ho SY, Klautz RJM, Kose S, McMurray J, Perrone Filardi P, Raatikainen P, Salvador MJ, Schalij MJ, Shpektor A, Sousa J, Stepinska J, Uuetoa H, Zamorano JL, Zupan I (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31(19):2369–2429. doi:10.1093/eurheartj/ehq278 PubMedCrossRef

Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M (2011) Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: prevention of Stroke and Systemic Thromboembolism in Atrial Fibrillation and Flutter. Can J Cardiol 27(1):74–90. doi:10.1016/j.cjca.2010.11.007 PubMedCrossRef

Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Smith SC, Jr., Priori SG, Estes NA, 3rd, Ezekowitz MD, Jackman WM, January CT, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Hochman JS, Kushner FG, Ohman EM, Tarkington LG, Yancy CW (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. In: Circulation, vol 123. vol 10. United States, pp e269-367. doi:10.1161/CIR.0b013e318214876d

Wann LS, Curtis AB, Ellenbogen KA, Estes Iii NAM, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ (2011) 2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (update on dabigatran)a report of the American college of cardiology foundation foundation/American heart association task force on practice guidelines. J Am Coll Cardiol 57(11):1330–1337. doi:10.1016/j.jacc.2011.01.010 PubMedCrossRef

Wann LS, Curtis AB, Ellenbogen KA, Estes NAM, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK (2011) 2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (update on dabigatran): a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation 123(10):1144–1150. doi:10.1161/CIR.0b013e31820f14c0 PubMedCrossRef

Hylek EM, Skates SJ, Sheehan MA, Singer DE (1996) An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 335(8):540–546. doi:10.1056/nejm199608223350802 PubMedCrossRef

10.

Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141(10):745–752PubMedCrossRef

11.

Harenberg J (2009) New anticoagulants in atrial fibrillation. Semin Thromb Hemost 35(06):574–585. doi:10.1055/s-0029-1240018 PubMedCrossRef

12.

Harenberg J (2008) Development of new anticoagulants: present and future. Semin Thromb Hemost 34(08):779–793. doi:10.1055/s-0029-1145260 PubMedCrossRef

13.

Levine MN, Raskob G, Landefeld S, Kearon C (2001) Hemorrhagic complications of anticoagulant treatment. Chest 119(1 Suppl):108S–121SPubMedCrossRef

14.

Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, Singer DE (2003) Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 349(11):1019–1026. doi:10.1056/NEJMoa022913 PubMedCrossRef

15.

van Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ (2006) Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest 129(5):1155–1166. doi:10.1378/chest.129.5.1155 PubMedCrossRef

16.

Dolan G, Smith LA, Collins S, Plumb JM (2008) Effect of setting, monitoring intensity and patient experience on anticoagulation control: a systematic review and meta-analysis of the literature. Curr Med Res Opin 24(5):1459–1472. doi:10.1185/030079908x297349 PubMedCrossRef

17.

Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151. doi:10.1056/NEJMoa0905561 PubMedCrossRef

18.

Rationale and Design of the ROCKET AF study (2010) Rivaroxaban—Once daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation. American Heart Journal 159(3):340–347. doi:10.1016/j.ahj.2009.11.025 CrossRef

19.

Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM (2011) Rivaroxaban versus Warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891. doi:10.1056/NEJMoa1009638 PubMedCrossRef

20.

Lopes RD, Alexander JH, Al-Khatib SM, Ansell J, Diaz R, Easton JD, Gersh BJ, Granger CB, Hanna M, Horowitz J (2010) Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J 159(3):331–339. doi:10.1016/j.ahj.2009.07.035 PubMedCrossRef

21.

Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L (2011) Apixaban versus Warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992. doi:10.1056/NEJMoa1107039 PubMedCrossRef

22.

Harenberg J, Marx S, Wehling M (2012) Head-to-head or indirect comparisons of the novel oral anticoagulants in atrial fibrillation: what’s next? Thromb Haemost. doi:10.1160/TH12-07-0463

23.

Freeman JV, Zhu RP, Owens DK, Garber AM, Hutton DW, Go AS, Wang PJ, Turakhia MP (2011) Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med 154(1):1–11. doi:10.1059/0003-4819-154-1-201101040-00289 PubMedCrossRef

24.

Sorensen SV, Kansal AR, Connolly S, Peng S, Linnehan J, Bradley-Kennedy C, Plumb JM (2011) Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation:a Canadian payer perspective. Thromb Haemost 105(5):908–919. doi:10.1160/th11-02-0089 PubMedCrossRef

25.

Pink J, Lane S, Pirmohamed M, Hughes DA (2011) Dabigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses. BMJ (Clinical research ed) 343:d6333CrossRef

26.

Kansal AR, Sorensen SV, Gani R, Robinson P, Pan F, Plumb JM, Cowie MR (2012) Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation. Heart 98(7):573–578. doi:10.1136/heartjnl-2011-300646 PubMedCentralPubMedCrossRef

27.

Langkilde L, Asmussen M, Overgaard M (2012) Cost-effectiveness of dabigatran etexilate for stroke prevention in non-valvular atrial fibrillation. Applying RE-LY to clinical practice in Denmark. J Med Econ 15(4):695–709. doi:10.3111/13696998.2012.673525.PubMedCrossRef

28.

Davidson T, Husberg M, Janzon M, Oldgren J, Levin LA (2012) Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden. Eur Heart J 34(3):177–183. doi:10.1093/eurheartj/ehs157 PubMedCrossRef

29.

Lee S, Anglade MW, Pham D, Pisacane R, Kluger J, Coleman CI (2012) Cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation. Am J Cardiol 5(4):472–479. doi:10.1016/j.amjcard.2012.05.011

30.

Deitelzweig S, Amin A, Jing Y, Makenbaeva D, Wiederkehr D, Lin J, Graham J (2012) Medical cost reductions associated with the usage of novel oral anticoagulants vs warfarin among atrial fibrillation patients, based on the RE-LY, ROCKET-AF, and ARISTOTLE trials. J Med Econ 15(4):776–785. doi:10.3111/13696998.2012.680555 PubMedCrossRef

31.

Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Mak 13(4):322–338CrossRef

32.

Beck JR, Pauker SG (1983) The Markov process in medical prognosis. Med Decis Mak 3(4):419–458CrossRef

33.

Amtliche Sterbetafeln und Entwicklung der Sterblichkeit (https://www.destatis.de/DE/Publikationen/WirtschaftStatistik/Bevoelkerung/AmtlicheSterbetafeln_32011.pdf?__blob=publicationFile,abgerufen am 27.01.2013)

34.

Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB (1996) Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA, J Am Med Assoc 276(15):1253–1258CrossRef

35.

Adam H, Ahlert M, Breyer F, Cassel D, Daumann F, Eisen R, Ernst C, Felder S, Firnkorn H-J, v. d. Schulenburg J-M, Greiner W, Henke K-D, Jacobs K, Karmann A, Kifmann M, Kuhn M, Leidl R, Neubauer G, Nuscheler R, Oberender P, Prinz A, Ried W, Schellhorn M, Schneider M, Ulrich V, Wambach A, Wasem J, Wille E (2009) Dokumentation der Stellungnahmen zum „Entwurf einer Methodik für die Bewertung von Verhältnissen zwischen Nutzen und Kosten im System der deutschen gesetzlichen Krankenversicherung Version 2.0“. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Retrieved September 1, 2012 from https://www.iqwig.de/download/Wuerdigung_der_Stellungnahmen_KNB-Methodenentwurf_2.0.pdf

36.

Statistisches Bundesamt Deutschland, Hrsg. Periodensterbetafeln für Deutschland 2007/2009 (http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Content/Statistiken/Bevoelkerung/GeburtenSterbefaelle/AktuellLebenserwartung,templateId=renderPrint.psml,abgerufen am 05.07.2011)

37.

Shah SV, Gage BF (2011) Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation. Circulation 123(22):2562–2570. doi:10.1161/circulationaha.110.985655 PubMedCrossRef

38.

InEK gGmbH, Hrsg. Vereinbarung zum Fallpauschalensystem für Krankenhäuser für das Jahr 2011 (2010) (http://www.g-drg.de/cms/G-DRG-System_2011/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2011; abgerufen am 10.07.2011). http://www.g-drg.de/cms/G-DRG-System_2011/Fallpauschalen-Katalog/Fallpauschalen-Katalog_2011

39.

Drummond MF, Sculpher MJ, Torrance GW, O′Brien BJ, Stoddart GL (eds) (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford Univ. Press, NY

40.

Hay JW, Smeeding J, Carroll NV, Drummond M, Garrison LP, Mansley EC, Mullins CD, Mycka JM, Seal B, Shi L (2010) Good research practices for measuring drug costs in cost effectiveness analyses: issues and recommendations: the ISPOR Drug Cost Task Force report–Part I. Value Health 13(1):3–7. doi:10.1111/j.1524-4733.2009.00663.x PubMedCrossRef

41.

Gage BF, Cardinalli AB, Owens DK (1996) The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med 156(16):1829–1836PubMedCrossRef

42.

O’Brien CL, Gage BF (2005) Costs and effectiveness of ximelagatran for stroke prophylaxis in chronic atrial fibrillation. JAMA, J Am Med Assoc 293(6):699–706. doi:10.1001/jama.293.6.699 CrossRef

43.

Fryback DG, Dasbach EJ, Klein R, Klein BE, Dorn N, Peterson K, Martin PA (1993) The Beaver Dam Health Outcomes Study: initial catalog of health-state quality factors. Med Decis Mak 13(2):89–102CrossRef

44.

Sullivan PW, Ghushchyan V (2006) Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Mak 26(4):410–420. doi:10.1177/0272989x06290495 CrossRef

45.

Tengs TO, Lin TH (2003) A meta-analysis of quality-of-life estimates for stroke. Pharmacoeconomics Vols. 21,3:191–200CrossRef

46.

Thomson R, Parkin D, Eccles M, Sudlow M, Robinson A (2000) Decision analysis and guidelines for anticoagulant therapy to prevent stroke in patients with atrial fibrillation. Lancet 355(9208):956–962. doi:10.1016/s0140-6736(00)90012-6 PubMedCrossRef

47.

Bufe A, Frey S, Briswalter S (2009) Durch Blutungen verursachte Kosten bei der Therapie des akuten Koronarsyndroms in Deutschland. Herz 34(6):479–484PubMedCrossRef

48.

Guidelines for the economic evaluation of health technologies: Canada [3rd Edition] (2006). Canadian Agency for Drugs and Technologies in Health, Ottawa

49.

Von der Schulenburg JM, Greiner W, Jost F, Klusen N, Kubin M, Leidl R, Mittendorf T, Rebscher H, Schöffski O, Vauth C, Volmer T, Wahler S, Wasem J, Weber C, Konsens uMdH (2007) German recommendations on health economic evaluation—third and updated version of the Hanover Consensus. Gesundheitsökon Qualitätsmanage 12:285–290

50.

Rote Liste Online. http://www.rote-liste.de. Accessed 28 April 2013

51.

Hein L (2011) Arzneimittelverordnungs-Report 2011 - Antithrombotika und Antihämorrhagika. Springer-Verlag Berlin Heidelberg NewYork. doi:10.1007/978-3-642-21992-4_15

52.

Adcock AK, Lee-Iannotti JK, Aguilar MI, Hoffman-Snyder CR, Wingerchuk DM, Wellik KE, Demaerschalk BM (2012) Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation?: a critically appraised topic. Neurologist 18(2):102–107. doi:10.1097/NRL.0b013e318247bcb6 PubMedCrossRef

53.

Kamel H, Johnston SC, Easton JD, Kim AS (2012) Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or transient ischemic attack. Stroke 43(3):881–883. doi:10.1161/STROKEAHA.111.641027 PubMedCrossRef

54.

Harrington AR, Armstrong EP, Nolan PE Jr, Malone DC (2013) Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation. Stroke 44(6):1676–1681. doi:10.1161/STROKEAHA.111.000402 PubMedCrossRef

55.

Kansal AR, Sharma M, Bradley-Kennedy C, Clemens A, Monz BU, Peng S, Roskell N, Sorensen SV (2012) Dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation in Canada. Comparative efficacy and cost-effectiveness. Thromb Haemost 108(4):672–682. doi:10.1160/TH12-06-0388 PubMedCrossRef

56.

Harenberg J, Marx S, Diener HC, Lip GY, Marder VJ, Wehling M, Weiss C (2012) Comparison of efficacy and safety of dabigatran, rivaroxaban and apixaban in patients with atrial fibrillation using network metaanalysis. Int Angiol 31(4):330–339PubMed

57.

Carr-Hill RA (1992) Health related quality of life measurement–Euro style. Health policy 20(3):321–328 Discussion 329–332PubMedCrossRef

58.

Lereun C, Wells P, Diamantopoulos A, Rasul F, Lees M, Sengupta N (2011) An indirect comparison, via enoxaparin, of rivaroxaban with dabigatran in the prevention of venous thromboembolism after hip or knee replacement. J Med Econ 14(2):238–244. doi:10.3111/13696998.2011.564699 PubMedCrossRef

59.

Claes C, Mittendorf T, Grond M, Graf von der Schulenburg J-M (2009) Inkrementelle Kosteneffektivität von Dipyridamol + Acetylsalicylsäure in der Sekundärprävention bei ischämischem nichtkardioembolischem Schlaganfall. Med Klin 103(11):778–787. doi:10.1007/s00063-008-1122-z CrossRef

60.

Lee S, Anglade MW, Meng J, Hagstrom K, Kluger J, Coleman CI (2012) Cost-effectiveness of apixaban compared with aspirin for stroke prevention in atrial fibrillation among patients unsuitable for warfarin. Circ Cardiovasc Qual Outcomes 5(4):472–479. doi:10.1161/CIRCOUTCOMES.112.965251 PubMedCrossRef

Title: Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries
Authors: Martin Krejczy
Job Harenberg
Svetlana Marx
Konrad Obermann
Lutz Frölich
Martin Wehling
Publication date: 01-05-2014
Publisher: Springer US
Published in: Journal of Thrombosis and Thrombolysis / Issue 4/2014
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-013-0989-6

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2014

Thrombolysis in patients with pulmonary embolism and elevated heart-type fatty acid-binding protein levels

Comparative efficacy of in vitro and in vivo metabolized aspirin in the DeBakey ventricular assist device

Factor-Xa inhibitors protect against systemic oxidant damage induced by peripheral-ischemia reperfusion

Small hepatic veins Budd–Chiari syndrome

Erratum to: Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data

Evaluation of initial heparin infusion rates for a high-dose protocol

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials