All patients with venous thromboembolism should receive anticoagulant treatment in the absence of absolute contraindications

 

Abstract

All patients with venous thromboembolism should receive anticoagulant treatment in the absence of absolute contraindications. Initial anticoagulant treatment is crucial to reduce mortality, prevent early recurrences and improve long-term outcome. Treatment and patient disposition should be tailored on the severity of clinical presentation, on comorbidities and on the potential to receive appropriate care in the outpatient setting. Direct oral anticoagulants used in fixed doses without laboratory monitoring are the agents of choice for the treatment of acute venous thromboembolism in the majority of patients. In comparison with conventional anticoagulation (parenteral anticoagulants followed by vitamin K antagonists), these agents showed an improved safety (relative risk [RR] of major bleeding 0.61, 95% CI 0.45-0.83) with a similar risk of recurrence (RR 0.90, 95% CI 0.77-1.06). Vitamin K antagonists or low-molecular weight heparins are still an alternative to direct oral anticoagulants for the treatment of venous thromboembolism in specific patient categories as those with severe renal failure and the antiphospholipid syndrome or cancer, respectively. On the top of therapeutic anticoagulation, probably less than 10% of patients require reperfusion by thrombolysis or interventional treatments and these are hemodynamically unstable patients with acute pulmonary embolism and a minority of patients with proximal limb-threatening deep vein thrombosis. The choice should be driven by the combination of evidence from clinical trials and local expertise. The majority of patients with acute deep vein thrombosis and a proportion of selected hemodynamically stable patients with acute pulmonary embolism can be safely managed as outpatients.

PMID: 31917399 [PubMed - as supplied by publisher]

12:39

Photo

Not included, change data exporting settings to download.

256×256, 6.0 KB

12:39

In reply to this message

pubmed: caandvteortroorpul

Novel Antithrombotic Strategies for Treatment of Venous Thromboembolism.

Novel Antithrombotic Strategies for Treatment of Venous Thromboembolism.

Blood. 2020 Jan 09;:

Authors: Weitz JI, Chan NC