title: Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants.
abstract: Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice.
authors.affiliation: Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, United Kingdom. Electronic address: alexander.cohen@kcl.ac.uk.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Medicine, Hospital Kuala Lumpur, Malaysia.
authors.forename: Sinnadurai
authors.initials: S
authors.lastname: Jeyaindran
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
authors.forename: Jae Yeol
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Vascular Surgery, Daegu-Catholic University Hospital, South Korea.
authors.forename: Kihyuk
authors.initials: K
authors.lastname: Park
authors.affiliation: Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Suree
authors.initials: S
authors.lastname: Sompradeekul
authors.affiliation: Division of Hematology-Medical Oncology, Department of Internal Medicine, School of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Karmel L
authors.initials: KL
authors.lastname: Tambunan
authors.affiliation: Clinical Haematology, The Alfred Hospital, Melbourne, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne Australia.
authors.forename: Huyen
authors.initials: H
authors.lastname: Tran
authors.affiliation: Department of Medical Imaging, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Tsai
authors.affiliation: Department of Haematology and Transfusion Medicine, Royal North Shore Hospital; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ward
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, N.T. Hong Kong, China.
authors.forename: Raymond
authors.initials: R
authors.lastname: Wong
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D010139:Pacific Islands; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000473:pathology; D012307:Risk Factors
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant; Oral; PE; Pacific Asia; Pulmonary embolism; Treatment