Prophylaxis and treatment of venous thromboembolism based on Japanese clinical guides

Venous thromboembolism (VTE) has recently increased owing to the westernization of our food habits and an aging society in Japan. The Japanese Guidelines for VTE Prophylaxis were formulated and issued in 2004 and then revised in 2009. The incidence rates of symptomatic perioperative pulmonary thromboembolism (PTE) in Japan are being investigated by the Japanese Society of Anesthesiologists since 2002. The average rate of perioperative PTE was estimated to be 3.1 per 10,000 operations between 2002 and 2011. However, this rate significantly declined after the guidelines for thromboprophylaxis were issued and the management fee for PTE prophylaxis was covered by a health insurance in 2004. The average mortality rate was 17.9%, but it significantly decreased after new anticoagulants were approved in 2008. An anticoagulant, which is effective for both acute and long-term VTE treatment, is clearly beneficial and avoids the need for any form of overlapping therapy. The emerging oral antithrombotic compounds such as direct oral anticoagulants (DOACs), which have the potential to inhibit factor Xa, do not require laboratory monitoring. The oral administration of DOACs results in a benefit-to-risk ratio that is at least comparable with that provided by a conventional treatment with heparin followed by vitamin K antagonists.