Vol 7, No 3 (2016)
Review paper
Published online: 2017-02-23
Venous thromboembolism — practical aspects of treatment
Hematologia 2016;7(3):231-242.
Abstract
Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence due to population aging. The treatment of VTE is undergoing tremendous changes with the introduction of direct oral anticoagulants (DOAC), therefore clinicians need to understand the new treatment paradigms. The DOAC include dabigatran, which inhibits thrombin, and rivaroxaban, apixaban and edoxaban, which inhibit factor Xa. When compared with conventional VTE treatment consisting of a parenteral anticoagulant followed by a vitamin K antagonist, the DOAC were equally effective for prevention of recurrence, but were associated with less bleeding. This paper identifies VTE patients, who are or are not candidates for DOAC, provides guidance on how to choose among DOAC, discusses the optimal treatment duration for VTE and finally, reviews the management of bleeding, including the role of specific reversal agents. Furthemore, this article provides clinical guidance, based on the newest existing guidelines and consensus expert opinion, on the management of patients presenting with cancer-associated VTE, patients with VTE and thrombocytopenia or renal insufficiency, as well as patients with venous thrombosis in unusual sites, such as splanchnic vein thrombosis, cerebral vein thrombosis and retinal vein occlusion.
Keywords: venous thromboembolismdirect oral anticoagulantscancer-associated venous thromboembolismthrombocytopeniarenal insufficiencycerebral vein thrombosissplanchnic vein thrombosisretinal vein occlusion
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