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Antithrombotic Management of Venous Thromboembolism: JACC Focus Seminar
Elizabeth Renner1, Geoffrey D Barnes1
1Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
Insights
Direct oral anticoagulants offer new treatment options for venous thromboembolism (VTE). These medications, including apixaban and rivaroxaban, are effective in initial treatment, primary treatment, and secondary prevention phases.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Venous thromboembolism (VTE) presents a substantial public health challenge.
- Anticoagulation management is the cornerstone of VTE treatment.
- The advent of four direct oral anticoagulants (DOACs) since 2010 has transformed VTE therapy selection.
Purpose of the Study:
- To review the current landscape of anticoagulation management for VTE.
- To highlight the role and application of DOACs in VTE treatment phases.
- To emphasize the importance of appropriate anticoagulant selection and monitoring.
Main Methods:
- Literature review of VTE management strategies.
- Analysis of the impact of DOACs on VTE treatment protocols.
- Examination of oral-only anticoagulation options in different treatment phases.
Main Results:
- DOACs, including apixaban and rivaroxaban, are now available for oral-only VTE treatment strategies from the initial phase.
- Low-dose apixaban or rivaroxaban can be utilized for secondary VTE prevention in select patients.
- DOACs are increasingly supported for managing cancer-associated VTE.
Conclusions:
- DOACs have significantly altered anticoagulation choices for VTE patients.
- Oral-only anticoagulation is feasible across all VTE treatment phases with DOACs.
- Careful selection and monitoring of anticoagulants are essential for optimal VTE patient outcomes.
Abstract:
Venous thromboembolism (VTE) is a significant public health burden. Management of anticoagulation is the mainstay of treatment for the vast majority of patients. The introduction of 4 direct oral anticoagulants beginning in 2010 has significantly affected selection of anticoagulants for patients with VTE. Treatment of VTE consists of 3 phases: the initial treatment (first 5 to 21 days), primary treatment (first 3 to 6 months), and secondary prevention (after the initial 3 to 6 months). Oral-only anticoagulation strategies are now available, using apixaban or rivaroxaban therapy, beginning in the initial treatment phase. In addition, low-dose anticoagulation with either apixaban or rivaroxaban can be used in the secondary prevention phase for appropriate patients. Use of the direct oral anticoagulants is now supported for many patients with cancer-associated VTE. Appropriate selection and monitoring of anticoagulants remains a critical element of high-quality care for patients with VTE.
