Balancing Anti-thrombotic Efficacy and Bleeding Risk in the Contemporary Management of Venous Thromboembolism

Abstract

Acute venous thromboembolism [VTE, encompassing deep venous thrombosis and pulmonary embolism (PE)] is a frequently encountered disease that produces substantial morbidity and mortality. In addition to the traditional treatment paradigm of parenteral anticoagulation bridging to treatment with a vitamin K antagonist (VKA) such as warfarin, there is now a new class of medications approved to treat acute VTE. Non-vitamin K direct oral anticoagulants produce rapid anticoagulation as compared to VKAs, and have substantially fewer drug and dietary side effects. However, concerns about bleeding risk, as well as general unfamiliarity with the medication class, have led to incomplete uptake by physicians. In this study, we describe the evidence-based rationale for the use of these medications. We also discuss comparative bleeding risks, and the approaching to bleeding in the anticoagulated patient.