Management of Venous Thromboembolism: Recent Advances in Oral Anticoagulation Therapy

Shannon W Finks, Toby C Trujillo, Paul P Dobesh, Shannon W Finks, Toby C Trujillo, Paul P Dobesh

Abstract

Objective: To review clinical data on direct oral anticoagulants (DOACs) used in the acute treatment of venous thromboembolism (VTE) as well as practical considerations when using these products.

Data sources: Searches of PubMed and Google Scholar for VTE, deep vein thrombosis, pulmonary embolism, and relevant drug international nonproprietary names were conducted. Additional online searches were conducted for prescribing information.

Study selection and data extraction: Relevant articles on dabigatran, rivaroxaban, apixaban, and edoxaban for the management of VTE compared with oral vitamin K antagonists (VKAs; published between 1966 and December 2015) were reviewed and summarized, together with information on dosing, pharmacokinetics/pharmacodynamics, and drug-drug interactions.

Data synthesis: The DOACs have the potential to circumvent many of the disadvantages of VKAs. At a minimum, they greatly increase the available therapeutic options, thus providing a greater opportunity for clinicians to select a management option that best fits the needs of individual patients. Despite the significant advance that DOACs represent, they are not without risk and require careful consideration of a number of clinical issues to optimize safety and efficacy.

Conclusions: The emergence of DOACs for the management of thromboembolic disorders represents a paradigm shift from oral VKAs. The DOACs provide similar efficacy and improved safety in selected patients as compared with VKAs. Clinicians treating VTE need to be familiar with the intricacies involved in using these agents, including the appropriate dose selection for the relevant indication, avoidance of drug-drug and drug-disease interactions, and consideration of dose adjustments in specific clinical situations, such as organ dysfunction.

Keywords: apixaban; dabigatran; deep vein thrombosis; direct oral anticoagulants; edoxaban; pulmonary embolism; rivaroxaban; target-specific oral anticoagulants; venous thromboembolism.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Finks reports no conflicts of interest, including, but not limited to, consulting fees, paid expert testimony, employment, grants, honoraria, patents, royalties, stocks, or other financial or material gain that may involve the subject matter of the manuscript. Dr Trujillo serves as a consultant for Boehringer Ingelheim, Janssen, and BMS/Pfizer. Dr Dobesh serves as a consultant for Boehringer Ingelheim, Janssen, BMS/Pfizer, and Daiichi Sankyo and has received research funding from Daiichi Sankyo.

© The Author(s) 2016.

Figures

Figure 1.
Figure 1.
Noninferiority analysis for venous thromboembolism treatment trials.- Abbreviations: DVT, deep vein thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism. a Relative risk.

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