Abstract
Traditional anticoagulants, such as warfarin and enoxaparin, have several limitations, including parenteral administration, need for laboratory monitoring, and ongoing dose adjustment, which may limit optimal patient care. Newer oral anticoagulants, such as direct thrombin inhibitors (e.g., dabigatran etexilate) and direct factor Xa inhibitors (e.g., rivaroxaban, apixaban, and edoxaban), have been developed to overcome these drawbacks, and thereby improve patient care. Several of these agents have been approved for use in the prevention and treatment of venous and/or systemic thromboembolism. The objective of this paper is to provide an overview of the available clinical trial data for these new oral anticoagulants in the prevention and treatment of venous thromboembolism and a practical update for clinicians.
Highlights
Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE)
The objective of this paper is to provide an overview of the available clinical trial data for these new oral anticoagulants in the prevention and treatment of venous thromboembolism and a practical update for clinicians
The incidence of hospitalacquired DVT based on objective diagnostic screening is 10– 40% among medical or general surgical patients and 40– 60% among patients who have undergone major orthopedic surgery such as total knee replacement (TKR), total hip replacement (THR), and hip fracture surgery [5]
Summary
Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). The efficacy of traditional anticoagulants in preventing VTE in patients undergoing major orthopedic surgery and in hospitalized acutely ill medical patients is well established [5, 8,9,10,11] These agents have several limitations that may limit optimal patient care, such as their parenteral administration, need for laboratory monitoring, and ongoing dose adjustment (Table 1) [12,13,14,15,16]. Newer oral anticoagulants, such as direct thrombin inhibitors (e.g., dabigatran etexilate) and direct factor Xa inhibitors (e.g., rivaroxaban, apixaban, and edoxaban), have been developed to overcome these drawbacks, and thereby improve patient care.
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