title: The potential of target-specific oral anticoagulants for the acute and long-term treatment of venous thromboembolism.
abstract: BACKGROUND
  Venous thromboembolism (VTE) comprises both deep vein thrombosis and pulmonary embolism. VTE is a leading cause of morbidity and mortality worldwide and its increasing incidence and prevalence are a major health concern. The primary medical objective during the acute phase of VTE treatment is to prevent thrombus extension and embolization. Extended treatment aims to prevent or minimize long-term complications, such as recurrent VTE, post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension.
  
  
  METHODS
  Anticoagulant therapy has been the mainstay of treatment for VTE and traditionally involves initial therapy with heparin, overlapping with and followed by a vitamin K antagonist. Although effective, standard heparin/vitamin K antagonist therapy has several limitations that can be overcome by more recently developed target-specific oral anticoagulants (TSOACs). These agents have predictable pharmacokinetics, a rapid onset of action and few drug-drug or drug-food interactions. Furthermore, TSOACs offer convenient anticoagulation without the need for routine coagulation monitoring and dose adjustment.
  
  
  RESULTS
  The efficacy and safety data from phase III clinical trials support the use of TSOACs for VTE treatment, including in special patient populations. Risk-stratification tools and strategies have been developed to assist physicians in managing anticoagulation treatment.
  
  
  CONCLUSIONS
  Rivaroxaban is the first TSOAC to gain widespread approval for the treatment of acute deep vein thrombosis and pulmonary embolism and the long-term prevention of recurrent VTE as monotherapy. Dabigatran has also been approved for this indication recently. TSOACs, especially as monotherapy, represent a paradigm shift in clinical practice for the management of patients with VTE.
authors.affiliation: School of Medicine, University of Rochester , Rochester, NY , USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Akwaa
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D000069604:Dabigatran; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy*; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000188:drug therapy*; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D006493:Heparin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulants; Bleeding; Clinical trial; Phase III; Risk assessment; Venous thromboembolism/complications