warfarin / Generic mfg. - LARVOL DELTA

Application of acoustic ejection mass spectrometry for plasma protein binding assay using flux dialysis. (PubMed, Drug Metab Dispos) - "Herein, we validated this approach using 10 commercially available compounds with known fu values-imipramine, indomethacin, itraconazole, lapatinib, nicardipine, warfarin, chlorpromazine, rivastigmine, zonisamide, and ritonavir-with a wide fu range covering from very high binding (fu ≤ 0.01) to low binding (fu > 0.10) in human plasma. SIGNIFICANCE STATEMENT: This study bridges the gap between flux dialysis and acoustic ejection mass spectrometry by creating a synergistic analytical framework for plasma protein binding assays, addressing limitations of both methods and enabling high-throughput applications with improved accuracy and efficiency. The combination of flux dialysis and acoustic ejection mass spectrometry will make a positive contribution to the development of high-throughput in vitro absorption, distribution, metabolism and excretion assays in drug discovery."

Journal

Transitioning patients from warfarin to direct oral anticoagulants: A dual-benefit quality improvement initiative (ASH 2025) - "The implementation of a quality improvement initiative offering cost-reduced DOAC therapy led to a statistically significant increase in the number of patients transitioned off of warfarin therapy. Subsequently, transitioning eligible patients from warfarin to DOAC therapy improved the overall effectiveness of anticoagulation and decreased bleeding risk among those who had a first-line indication for warfarin therapy, potentially due to reduced patient volume and improved physician resource allocation. Access to DOAC therapy was enhanced in racial minority and socioeconomically disadvantaged groups."

Clinical • Atrial Fibrillation • Cardiovascular • Genetic Disorders • Hematological Disorders • Thrombosis

Developing a protocol for bloodless medicine patients undergoing transfusion-free kidney transplantation (ASH 2025) - "Our CTFM-KT protocol targets 3 identifiable challenges: establishing pre-transplant hemoglobin (Hb) thresholds, using plasma-free INR-reversal agents for Warfarin-based anticoagulation, and managing post-transplant anemia...Our CFTM protocol emphasizes blood-management concepts using prior data on ASCTs and cardiovascular surgery to allow JW populations to be considered for LDKT and DDKT at our institution. By creating a pre-operative Hb threshold, offering plasma-free alternative agents for anticoagulation reversal, and holistic evaluation with multi-disciplinary involvement, our CFTM will be able to collect longitudinal data on clinical outcomes of JW patients undergoing KT to increase the accessibility of a life-prolonging procedure."

Clinical • Cardiovascular • Hematological Disorders • Infectious Disease • Nephrology • Transplantation

Real-world comparative bleeding outcomes of direct oral anticoagulants versus warfarin in adults: Insights from observational evidence (ASH 2025) - "Background: Direct oral anticoagulants (DOACs) – apixaban, rivaroxaban, dabigatran, and edoxaban– are increasingly preferred over warfarin for stroke prevention in atrial fibrillation and treatment of venous thromboembolism. This review provides robust real-world evidence that DOACs offer a superior safety and effectiveness profile compared to warfarin in adult patients requiring anticoagulation. DOACs significantly reduce the incidence of ICH and stroke– two of the most clinically devasting complications– while maintaining comparable or lower rates of major and GI bleeding. These findings validate guideline recommendations and strongly support the preferential use of DOACs as the standard of care for anticoagulation in everyday clinical practice."

Clinical • Real-world • Real-world evidence • Atrial Fibrillation • Cerebral Hemorrhage • CNS Disorders • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Venous Thromboembolism

Outcomes with prophylactic anticoagulation in hemolytic anemias: A systematic review (ASH 2025) - "Prophylactic anticoagulation with either warfarin or LMWH appears to reduce VTE events in patients with PNH and AIHA. However, there is a lack of high-quality data from randomized trials. Further trials are needed to consolidate efficacy and to report on complications with anticoagulation, and the overall impact on survival and mortality."

Review • Anemia • Autoimmune Hemolytic Anemia • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Complement-mediated Rare Disorders • Hematological Disorders • Immunology • Paroxysmal Nocturnal Hemoglobinuria • Rare Diseases • Venous Thromboembolism

Beyond the assays: Managing unresolvable TMA and the pharmacokinetic cost of plasma exchange (ASH 2025) - "Case presentation: A 73-year-old man with history of Tetralogy of Fallot with bioprosthetic aortic valve replacement on warfarin and CKD stage IIIb (baseline creatinine 1.7–1.8 mg/dL) presented with two weeks of progressive jaundice, anorexia, and fatigue...Under the suspicion of complement-mediated Hemolytic Uremic Syndrome (HUS), PLEX was held, meningococcal vaccination administered, and penicillin V prophylaxis initiated...PLEX was resumed followed by Rituximab infusion and a 7-day steroid taper...A second dose of Ravulizumab was administered two weeks after the initial dose, at which point PLEX was discontinued...Therefore, beyond emphasizing pre-PLEX sampling to avoid dilutional false negatives, this case highlights the need for rapid, discriminatory biomarkers and protocols that reconcile the competing demands of urgent PLEX and sustained complement inhibition. Finally, elderly patients with limited reserve may sustain permanent organ damage even with optimal..."

PK/PD data • Anorexia • Atypical Hemolytic Uremic Syndrome • Chronic Kidney Disease • Gastroenterology • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Meningococcal Infections • Nephrology

The clot thickens: Diagnosing APS in the setting of multifocal thrombosis (ASH 2025) - "She was admitted to the ICU and started on dexamethasone, antibiotics, diuretics, and therapeutic heparin...She was discharged on warfarin with appropriate follow-up... This case highlights the complex interplay of autoimmune, cardiac, and infectious triggers of thrombosis. COVID-19 also potentiated thrombus formation in a patient with underlying APS. Early echocardiography, surgical intervention, and anticoagulation were key to survival."

Cardiovascular • CNS Disorders • Congestive Heart Failure • Epilepsy • Genetic Disorders • Heart Failure • Hematological Disorders • Hypertension • Immunology • Infectious Disease • Inflammatory Arthritis • Ischemic stroke • Mood Disorders • Novel Coronavirus Disease • Pulmonary Disease • Thrombosis

Recurrent splenic infarction in triple-positive antiphospholipid syndrome despite therapeutic anticoagulation (ASH 2025) - "She was discharged on Apixaban. This case highlights the rarity of splenic infarction as an initial presentation of triple-positive APS. Although APS is commonly associated with thromboembolic events, splenic involvement is unusual and maybe easily overlooked. The patient's progression of infarcts, despite a therapeutic INR raised concern for possible warfarin resistance, a rare but important consideration in triple-positive APS."

Atrial Fibrillation • Cardiovascular • Genetic Disorders • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Ischemic stroke • Obstetrics • Thrombocytopenia • Vasculitis

Evolving catastrophic antiphospholipid syndrome with intracerebral hemorrhage: Treatment with plasma exchange and rituximab (ASH 2025) - "Apixaban was discontinued; enoxaparin 1 mg/kg twice daily, aspirin, prednisone 1 mg/kg with taper, and rituximab 375 mg/m² weekly ×4 were initiated...He was bridged from enoxaparin to warfarin (INR goal 2–3) for indefinite anticoagulation given APS and atrial fibrillation...Given higher recurrent thrombosis with direct oral anticoagulants reported in highrisk APS, vitamin K antagonists remain preferred for longterm therapy when feasible; multidisciplinary coordination is essential to individualize immunomodulation, anticoagulant selection, and timing. Disclaimer The views expressed in this abstract are those of the author(s) and do not necessarily reflect the official policy or position of the Defense Health Agency, the Department of Defense, or the U.S. Government."

Acute Kidney Injury • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Complement-mediated Rare Disorders • Genetic Disorders • Hematological Disorders • Immunology • Inflammatory Arthritis • Ischemic stroke • Nephrology • Renal Disease • Thrombocytopenia • Thrombosis

Targeting early immunologic decline in acquired hemophilia A: A case for prophylactic rituximab (ASH 2025) - "We present the case of an 81-year-old man with idiopathic AHA and a mechanical aortic valve on chronic coumadin...Following treatment with triple immunosuppressive therapy including prednisone, rituximab, and cyclophosphamide, he achieved remission...Beyond its clinical impact, this approach may also offer significant cost savings by reducing the need for costly agents such as recombinant FVIII (obizur) or emicizumab. Further investigation is warranted to define relapse thresholds, evaluate safety, and determine the broader applicability of prophylactic immunosuppression in AHA patients."

Clinical • Cardiovascular • Hematological Disorders • Hemophilia • Hemophilia A • Immunology • Rare Diseases • Thrombocytopenic Purpura

Acquired FVIII deficiency in the setting of prior mechanical mitral valve replacement: A delicate balance of competing hemorrhagic and thrombotic risks (ASH 2025) - "Most included cases involved management strategies where immunosuppression with corticosteroids (e.g., prednisone 1 mg/kg/day) combined with cyclophosphamide (1–2 mg/kg/day) or rituximab was initiated promptly to eradicate the inhibitor. Acquired FVIII deficiency in patients with prior MVR is a rare but critical clinical challenge. It is a condition that mandates prompt initiation of immunosuppression while necessitating cautious deliberation of the timing and degree of anticoagulation. Our literature review and experience suggest that FVIII activity >50% may serve as a reasonable threshold to cautiously resume warfarin in these patients."

Cardiovascular • Hematological Disorders • Hemophilia • Hemophilia A • Rare Diseases • Thrombosis

Enhancing anticoagulation stewardship: A resident-focused quality improvement project (ASH 2025) - "Clinical Component: Patients at the outpatient resident clinic were screened for the following criteria: adults >18 years onchronic anticoagulation (e.g., warfarin, DOACs, low-molecular-weight heparin) for AF, VTE, or hematologicthrombophilia that completed minimum therapeutic duration of anticoagulation... This resident-led project improved confidence in anticoagulation management and identifying outpatientcandidates for safe de-escalation as both an education and quality improvement initiative. The findingssuggest that the primary barrier to anticoagulation management may be limited awareness of evolvingguidelines rather than patient complexity. Embedding anticoagulation stewardship into residencytraining may promote safer prescribing practices moving forward."

Atrial Fibrillation • Cardiovascular • Venous Thromboembolism

Comparative effectiveness and safety of apixaban vs. rivaroxaban in patients with cirrhosis and portal vein thrombosis: An analysis of real-world data (ASH 2025) - "Anticoagulation is recommended to treat PVT despite low-certaintyevidence, largely derived from studies of heparin and warfarin. In this real-world cohort of patients with cirrhosis and PVT, apixaban and rivaroxaban were associatedwith similar effectiveness. Use of apixaban was associated with a lower incidence of bleeding thanrivaroxaban, although the CI included the null value of one. These findings are consistent with itsfavorable pharmacokinetic profile in hepatic impairment and with observations in other populations."

Clinical • HEOR • Real-world • Real-world evidence • Atrial Fibrillation • Biliary Cancer • Cardiovascular • Cerebral Hemorrhage • Chronic Kidney Disease • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Nephrology • Renal Disease • Thrombosis • Venous Thromboembolism

Healthcare Providers' knowledge and attitudes toward venous thromboembolism prophylaxis in multiple myeloma: A cross-sectional survey (ASH 2025) - "Among physicians, aspirin was themost prescribed VTE prophylaxis agent (55.6%), followed by direct oral anticoagulants (27.8%), low-molecular-weight heparin (11%), and warfarin (5.6%). This study reveals substantial variability in VTE risk assessment and prophylaxispractices in MM care. Although most participants exhibited moderate knowledge and positive attitudes,notable inconsistencies remain in risk stratification and clinical practice. These findings highlight the needfor targeted educational interventions and practice standardization."

Cardiovascular • Hematological Malignancies • Multiple Myeloma • Respiratory Diseases • Venous Thromboembolism

Risk of bleeding in 15,495 patients with myeloproliferative neoplasms by treatment type and thrombotic history (ASH 2025) - "Treatment categories were definedas follows: no therapy, anticoagulant monotherapy (e.g., warfarin, direct oral anticoagulants [DOACs]); antiplatelet monotherapy (e.g., aspirin, clopidogrel); cytoreductive monotherapy (e.g., hydroxyurea,interferon); and combination therapy, defined as any combination of at least two of the threeaforementioned therapies. Given that themajority of combination therapy regimens included antiplatelet agents, these results underscore thepotential protective role of antiplatelet therapy in managing bleeding risk. These insights may supportclinical decision-making, and guide personalized treatment strategies and risk assessment in patientsdiagnosed with MPN."

Clinical • Essential Thrombocythemia • Myelofibrosis • Myeloproliferative Neoplasm • Polycythemia Vera • Thrombocytosis • Thrombosis

Early access program for danicopan (ALXN2040) as add-on treatment to eculizumab or ravulizumab in patients with paroxysmal nocturnal hemoglobinuria (PNH): Preliminary data from the Italian real-world survey. (ASH 2025) - "Antithrombotic prophylaxis was reported in 4 patients (2warfarin and 2 low molecular weight heparin (LMWH)). to date, data from 10 of the treated patients are available (4 females, median age 41.5ys, range22-49, and 6 males, median age 58ys, range 33-86). Patients mainly suffered from classical PNH (80%),followed by PNH/aplastic anemia (PNH/AA, 20%). Median laboratory tests at the beginning of the C5iwere as follows: hemoglobin level (Hgb) 8.9 g/dl (range, 7.0-9.8), reticulocytes (Ret) count 180*10^6/L(range, 20-341), LDH value 5 x upper limit of normality (ULN) (range, 1.5-28)."

Clinical • Real-world • Real-world evidence • Anemia • Aplastic Anemia • Cardiovascular • Complement-mediated Rare Disorders • Hematological Disorders • Paroxysmal Nocturnal Hemoglobinuria • Rare Diseases • Thrombosis

Clinical manifestations, management, and outcomes in patients with triple positive antiphospholipid antibodies (ASH 2025) - "Prior use of warfarin was more common in individuals with IgG isotype (p=0.04) while current use wassimilar between both isotypes. Triple positive IgG individuals had more frequent prior use ofhydroxychloroquine (p=<0.01), however current use was comparable between both isotypes.ConclusionsOur results suggest that individuals with triple positive aPLs IgG isotype may be more prone to venousthrombosis and have underlying autoimmune disease. Additional larger studies are required to confirmour findings."

Clinical • Cardiovascular • Genetic Disorders • Hematological Disorders • Immunology • Inflammatory Arthritis • Obstetrics • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

Direct oral anticoagulation management to address primary and secondary adherence in atrial fibrillation (ASH 2025) - "Once thebarriers were identified several remediation approaches were incorporated in the process, theseincluded education about DOACS, medicare education , social work assistance to even switching towarfarin if necessary...Our engagedteam of pharmacy staff was able to manage those concerns with the education and cost mitigationstrategies leading to improved adherence.Based on previously published literature even a 5% difference in adherence to DOACS can make a hugedifference in population-based outcomes. Our work was able to demonstrate a positive impact of theintervention, highlighting the need for a well-managed DOAC unit especially for complex carepopulations."

Adherence • Atrial Fibrillation • Cardiovascular • Hematological Disorders • Thrombosis

Real-world outcomes of direct oral anticoagulants versus warfarin in patients with single-positive antiphospholipid antibody syndrome: A trinetx cohort analysis (ASH 2025) - "Acute MIrisk was increased with DOACs in aCL-positive patients. These results support the consideration ofDOACs as a therapeutic alternative to warfarin in select single-positive APS populations, but highlight theneed for prospective studies to clarify subgroup-specific risks."

Clinical • Real-world • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Genetic Disorders • Hematological Disorders • Immunology • Inflammatory Arthritis • Ischemic stroke • Myocardial Infarction • Respiratory Diseases

Impact of aspirin use on clinical outcomes in antiphospholipid syndrome patients with arterial thrombosis: A real-world cohort study (ASH 2025) - "In this large, real-world cohort of APS patients with arterial thrombosis, adding low-dose aspirin towarfarin was linked to a significantly higher risk of major bleeding—including gastrointestinalhemorrhage, hemoperitoneum, iron deficiency anemia, and blood transfusion—without any reduction inall-cause mortality. Importantly, rates of ischemic stroke and acute myocardial infarction were alsohigher in the aspirin group. This unexpected increase in arterial events may reflect residual confoundingby indication, as patients perceived to be at greater thrombotic risk were more likely to receivecombination therapy."

Clinical • Clinical data • Real-world • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastroenterology • Genetic Disorders • Hematological Disorders • Ischemic stroke • Myocardial Infarction • Thrombosis • TINCR

Outcomes and resource utilization during and after oral anticoagulant-related bleeding in chronic kidney disease (ORACLE-CKD): A population-based cohort study (ASH 2025) - "We accrued patients ≥66 years who were hospitalized for bleedingand had an OAC (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin) dispensed precedingadmission (April 2012 to March 2022). Patients hospitalized with OAC-related bleeding are at high risk of death during andimmediately following hospitalization. Mortality risk was greater among patients with CKD. Within 1 yearof hospital discharge, three-quarters of patients with moderate or severe CKD visited the ED, and overhalf were readmitted to hospital."

Clinical • HEOR • Alzheimer's Disease • Atrial Fibrillation • Chronic Kidney Disease • CNS Disorders • Congestive Heart Failure • Dementia • Gastroenterology • Heart Failure • Ischemic stroke • Myocardial Infarction • Nephrology • Renal Disease • Respiratory Diseases • Venous Thromboembolism

A propensity-matched analysis of real-world outcomes comparing direct oral anticoagulants and warfarin in patients diagnosed with portal vein thrombosis (ASH 2025) - "In PVT patients, warfarin therapy was linked to reduced short-term mortality but increasedrates of hepatic decompensation and other major bleeding in comparison to DOACs. The results highlightthe necessity for risk-benefit based individualized therapeutic choices in PVT patients."

Clinical • Real-world • Real-world evidence • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Liver Failure • Thrombosis

Incidence of arterial thromboembolism in patients with myeloproliferative neoplasms treated with anticoagulation for venous thromboembolism (ASH 2025) - "Therapeutic-doseanticoagulation for index VTE included direct oral anticoagulants (56, 53%), warfarin (36, 34%) andenoxaparin (13, 12%). At 30 days, 29 (28%) patients were also on antiplatelet therapy (all aspirin) and 56(53%) were receiving cytoreductive therapy (53 hydroxyurea, 3 ruxolitinib)...Theoverall ATE risk was numerically higher than the risk of major bleeding. These results highlight the needfor research on ATE risk reduction in patients with MPN on anticoagulation."

Clinical • Acute Coronary Syndrome • Dyslipidemia • Essential Thrombocythemia • Gastrointestinal Disorder • Hematological Malignancies • Hypertension • Ischemic stroke • Leukemia • Myelofibrosis • Polycythemia Vera • Respiratory Diseases • Thrombocytosis • Venous Thromboembolism • JAK2

Use of apixaban for the prevention of thrombosis in children with coronary artery aneurysms secondary to kawasaki disease (ASH 2025) - "After at least 6 months of enoxaparin and/or warfarin,patients are eligible to transition to weight-based, twice-daily apixaban. This descriptive, retrospective chart review highlights the real-world use of apixaban forthromboprophylaxis in high-risk KD patients with large coronary artery aneurysms or dilation. Despitethe small sample size and limited follow-up, our findings suggest that apixaban is a safe and effectiveoption in this population. However, important limitations remain."

Clinical • Heart Failure • Hematological Disorders • Myocardial Ischemia • Thrombosis

Antiplatelet therapy in anticoagulated cirrhotic patients with chronic portal vein thrombosis: A retrospective multicenter study (ASH 2025) - "We divided the patients into four groupsbased on their anticoagulation approach: DOAC alone, DOAC combined with antiplatelet therapy(APT), warfarin alone, and warfarin with APT...In patients with cirrhosis and chronic portal vein thrombosis, adding antiplatelet therapy,particularly alongside DOACs, did not seem to raise bleeding risk and was associated with a higherrate of thrombus resolution. Although this was a retrospective study with limitations, the resultssuggest that combining anticoagulation with antiplatelet therapy might benefit carefully selectedcases. Further prospective studies will be important to clarify the safety and effectiveness of thisapproach."

Retrospective data • Fibrosis • Gastroenterology • Heart Failure • Hematological Disorders • Hepatology • Immunology • Liver Cirrhosis • Thrombosis