title: Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era.
abstract: BACKGROUND
  Patients who have had a venous thromboembolic event are generally advised to receive anticoagulant treatment for 3 months or longer to prevent a recurrent episode. Current guidelines recommend initial heparin and an oral vitamin K antagonist (VKA) for long-term anticoagulation. However, because of the well-described disadvantages of VKAs, including extensive food and drug interactions and the need for regular anticoagulation monitoring, novel oral anticoagulants (NOACs) have become an attractive option in recent years. These agents are given at fixed doses and do not require routine coagulation-time monitoring. The NOACs are discussed in this review with regard to the needs of patients on long-term anticoagulation.
  
  
  METHODS
  Current guidelines from Europe and North America that refer to the treatment of deep vein thrombosis and/or pulmonary embolism are included, as well as published randomized Phase III clinical trials of NOACs. PubMed searches were used for sourcing case studies of long-term anticoagulant treatment, and results were filtered for human application and screened for relevance.
  
  
  CONCLUSIONS
  NOAC-based therapy showed a similar efficacy and safety profile to heparins/VKAs but without the need for regular anticoagulation monitoring or dietary adjustments, and can be taken as a fixed-dose regimen once or twice daily. This represents a significant step forward in facilitating the management of long-term anticoagulation therapy. Furthermore, in the EINSTEIN studies, improved patient satisfaction was documented with the NOAC rivaroxaban, which may result in better adherence to therapy and an overall reduction in the incidence of recurrent venous thromboembolism.
authors.affiliation: CGH Medical Center, Sterling, IL, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; University of Illinois School of Medicine, Peoria, IL, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D004334:Drug Administration Schedule; D018565:Food-Drug Interactions; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D055118:Medication Adherence; D017060:Patient Satisfaction; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; deep vein thrombosis; direct Factor Xa inhibitor; direct thrombin inhibitor; patient needs; pulmonary embolism; vitamin K antagonist