Access to and Awareness of DPI for Polyvascular Disease

Deepak Bhatt, MD, MPH: Sahil, you made a really good point when we were just schmoozing before about the vascular dose, the 2.5, the idea that with rivaroxaban that there's great data, and we're going to get into the data. But access can be an issue that in some hospitals­­—I won't name any of those hospitals in New York­—but there are hospitals in New York where it's been a challenge to even get it on the formulary.

Sahil Parikh, MD: Well, I think that some of it is stemming from the lack of awareness, and some of it is stemming from this issue of confusion and lack of clarity of what the purpose is and what the dose regimens have been carefully titrated to achieve. And hence, I think that can be an issue. Certainly, in the ambulatory arena, there's no bar. You can write a prescription for your patient and explain to them appropriately in the office and get them the medications they need, but certainly in the inpatient settings, or particularly in those vulnerable times where patients are coming in and then out of the hospital, there can be confusion. Thus, the pharmacies or the P&T [pharmacy & therapeutics] committees, sometimes raise objections. I think it's extremely clear, though, that the patients benefit in those peri procedural times as well, and we'll get into those data. We've essentially militated for the ability to have access to this therapy in our patients. But for those that get pushback, for example, I think it's just clear now that the data supports the application of this therapy for these patients, and we just need to make sure it's very, very clear for what is in and exactly which drug. I think the electronic medical record has helped us immensely with that. And there's clear order sets that can clarify any of those areas of ambiguity. Thus, we've assuaged those concerns. But I think in many sites, I would suspect, not too similar to my own set, there is confusion and we just have to just pound it with data and show them.

Deepak Bhatt, MD, MPH: Well, but that's why I asked you because I don't think the situation you described is unique. I'm sure that it's playing out at hospitals all over the country and probably all over the world for that matter.

Transcript Edited for Clarity