Back to Journals » Vascular Health and Risk Management » Volume 12

Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era

Authors Toth P

Received 6 May 2015

Accepted for publication 1 July 2015

Published 10 February 2016 Volume 2016:12 Pages 23—34

DOI https://doi.org/10.2147/VHRM.S88088

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Amudha Kadirvelu

Peer reviewer comments 2

Editor who approved publication: Dr Daniel Duprez


Peter P Toth1–3

1CGH Medical Center, Sterling, IL, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3University of Illinois School of Medicine, Peoria, IL, USA

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.
Conclusion: 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.

Keywords: anticoagulation, patient needs, vitamin K antagonist, direct thrombin inhibitor, direct Factor Xa inhibitor, deep vein thrombosis, pulmonary embolism

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]