title: Managing venous thromboembolism in Asia: winds of change in the era of new oral anticoagulants.
abstract: Despite advances in the management of venous thromboembolism (VTE), treatment of many patients worldwide, especially in Asia, remains inadequate and/or discordant with prevailing guidelines. Although epidemiological studies consistently report lower incidences of VTE in Asians than Caucasians, VTE rates in Asia have probably been gravely underestimated, partly due to comparatively lesser ascertainment. It is becoming evident that Asians are at much higher risk of VTE than was hitherto supposed. Nevertheless, VTE risk-assessment is not routine in Asia and thromboprophylaxis rates are much lower than in Western nations. It is important to base decisions about anticoagulation on individual circumstances and weigh the potential benefits and risks. The conventional VTE management paradigm is not ideal. New oral anticoagulants offer advantages over current modalities that may help to streamline patient care and reduce healthcare costs. Initially, they will be mainly used in uncomplicated cases and, in the absence of clear differences in efficacy or safety, convenience, tolerability/adherence and cost will determine treatment choice. There is clear scope to improve VTE prevention and treatment in Asia. Key priorities are raising awareness of best practice and properly implementing guidelines. Uncertainty about the burden of VTE and concern about bleeding are barriers. High-quality Asian epidemiological data are needed to guide healthcare policy and evidence-based practice. More data on the occurrence and management of bleeding complications in Asian patients are also required. Meanwhile, physicians should remain vigilant and strive to act early, decisively and appropriately to diagnose and treat VTE, particularly in patients at high risk.
authors: Vascular Medicine, King's College Hospital, London, United Kingdom. alexander.cohen@kcl.ac.uk
authors: Alexander
authors: A
authors: Cohen
authors: Kuan Ming
authors: KM
authors: Chiu
authors: Kihyuk
authors: K
authors: Park
authors: Sinnadurai
authors: S
authors: Jeyaindran
authors: Karmel L
authors: KL
authors: Tambunan
authors: Christopher
authors: C
authors: Ward
authors: Raymond
authors: R
authors: Wong
authors: Sung-Soo
authors: SS
authors: Yoon
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001208:Asia / Q000453:epidemiology; D015195:Drug Design; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D013923:Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants