Treatment of Venous Thromboembolism With New Anticoagulant Agents.
Venous thromboembolism (VTE) is a common disease associated with high risk for recurrences, death, and late sequelae, accounting for substantial health care costs. Anticoagulant agents are the mainstay of treatment for deep vein thrombosis and pulmonary embolism. The recent availability of oral anticoagulant agents that can be administered in fixed doses, without laboratory monitoring and dose adjustment, is a landmark change in the treatment of VTE. In Phase III trials, rivaroxaban, apixaban, edoxaban (antifactor Xa agents), and dabigatran (an antithrombin agent) were noninferior and probably safer than conventional anticoagulation therapy (low-molecular-weight heparin followed by vitamin K antagonists). These favorable results were confirmed in specific patient subgroups, such as the elderly and fragile. However, some patients, such as those with cancer or with intermediate- to high-risk pulmonary embolism, were underrepresented in the Phase III trials. Further clinical research is required before new oral anticoagulant agents can be considered standard of care for the full spectrum of patients with VTE.
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: cecilia.becattini@unipg.it.
Cecilia
C
Becattini
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
Giancarlo
G
Agnelli
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology*; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D011725:Pyridines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban / Q000008:administration & dosage; D012720:Severity of Illness Index; D016019:Survival Analysis; D013844:Thiazoles / Q000008:administration & dosage; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011725:Pyridines; D013844:Thiazoles; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
anticoagulant agents; pulmonary embolism; venous thrombosis