Abstract
(1) Aim: The aim of this study was to assess the preferences of oral anticoagulants (OA) in patients diagnosed with deep vein thrombosis (DVT) of lower limbs or non-valvular atrial fibrillation (AF) requiring anticoagulation for medium/long term. (2) Materials and methods: the study included consecutive patients admitted with a diagnosis of either acute DVT of lower limbs (without signs of pulmonary embolism) or non-valvular AF who required oral anticoagulation, in a time frame of 18 months from January 2017 until June 2018. The following data were recorded: demographic variables, comorbidities (ischemic heart disease, arterial hypertension, heart failure, stroke, peripheral artery disease, diabetes mellitus, obesity), type and dose of OA (acenocoumarol, dabigatran, apixaban, rivaroxaban), complications due to the use of OA. (3) Results: AF patients were older and had considerably more cardiovascular comorbidities than DVT patients. Vitamin K antagonists (VKA) were more likely to be administered in patients with AF, as they had indication for indefinite anticoagulation. VKA were more frequently prescribed in patients with ischemic heart disease, heart failure, and diabetes compared with DVT patients. Moreover, complications related to OA use were more frequent in the VKA group. Almost half of patients with acute DVT (48.5%) were treated with direct OA (DOAC) rather than VKA, and only a quarter of AF patients (24.8%) were treated with DOACs.
Highlights
Hypercoagulable state is an important issue in modern medicine, relevant to every clinical specialty including visceral, obstetrical, and orthopedic surgery or medical branches like cardiology, pulmonology, gastroenterology, oncology, internal medicine, and recently described COVID 19.The main triad of clot formation was depicted more than 100 years ago by Rudolf Virchow and includes hypercoagulation, parietal lesion, and blood stasis, and these aspects are ubiquitous in every case of thrombus formation [1]
The aim of this study was to assess the preferences of oral anticoagulant (OA) in patients diagnosed with deep vein thrombosis (DVT) of lower limbs or non-valvular atrial fibrillation (AF), who required anticoagulation for medium/long term
Indicated in venous thromboembolism (VTE) prevention, later in stroke prevention in AF, DAOCs have been shown to be effective in the treatment of acute DVT, replacing conventional therapy, heparins, and Vitamin K antagonists (VKA) in several patients [9,10]
Summary
Hypercoagulable state is an important issue in modern medicine, relevant to every clinical specialty including visceral, obstetrical, and orthopedic surgery or medical branches like cardiology, pulmonology, gastroenterology, oncology, internal medicine, and recently described COVID 19.The main triad of clot formation was depicted more than 100 years ago by Rudolf Virchow and includes hypercoagulation, parietal lesion, and blood stasis, and these aspects are ubiquitous in every case of thrombus formation [1]. Hypercoagulable state is an important issue in modern medicine, relevant to every clinical specialty including visceral, obstetrical, and orthopedic surgery or medical branches like cardiology, pulmonology, gastroenterology, oncology, internal medicine, and recently described COVID 19. A wide range of therapeutic approaches have been implemented to date, the most important one being the advent of the new oral anticoagulant era, more than ten years ago. From their first use in orthopedic surgery, especially in knee surgery, use of these drugs expanded across the field year after year in many other conditions like atrial fibrillation, deep vein thrombosis, and malignancies [2]. As studies the showed noninferiority of direct oral anticoagulants (DOAC) when compared to vitamin K antagonists (VKA) with the benefit of lower hemorrhagic events, choosing the oral anticoagulant (OA) involves evaluating the cost, the accessibility to monitoring INR (International Normalized Ratio), and the risk of having fluctuant INR due to patient characteristics or drug interactions [6]
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