Published online Feb 6, 2015. doi: 10.5315/wjh.v4.i1.1
Peer-review started: October 24, 2014
First decision: November 3, 2014
Revised: December 1, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 6, 2015
Venous thromboembolism (VTE) encompasses deep vein thrombosis and pulmonary embolism and is a major health burden, both medically and economically. Anticoagulation is the primary treatment and can be divided into three stages: initial, long term and extended treatment. Initial anticoagulation is given to reduce the risk of complications including fatal pulmonary embolism, while long term and extended treatment are aimed at prevention of recurrent VTE. Until recently, initial anticoagulation has only been achievable with administration of parental agents such as unfractionated or low molecular weight heparin, while vitamin K antagonists such as warfarin, have been the mainstay of long term and extended treatment. Factor-Xa inhibitors and direct thrombin inhibitors are oral anticoagulants that are being increasingly utilized as an alternative form of anticoagulation. This article aims to review the current guidelines in the management of VTE, the recent literature regarding novel anticoagulants in VTE, suggested treatment regimes and limitations.
Core tip: Novel oral anticoagulants (NOACs) are emerging as viable alternatives to Vitamin K antagonist (VKA) in the treatment of venous thromboembolism. Trials have shown that they are as efficacious as current standard treatment with low-molecular-weight heparin followed by VKA, and have potentially less bleeding associated with them. The regimes are simple and no monitoring is required and therefore it has the potential to reduce the burden of anticoagulation. Caution is required however, as testing of anticoagulant effect is limited and patient selection is important as many of the NOACs are metabolized in the liver and cleared by the kidney.