Current Treatments

VTE prevention: available therapies are underused

There are several pharmaceutical options for the prevention and treatment of thrombosis. However, lack of awareness of the utility of these medications as well as limitations of some of the agents can contribute to their underutilisation in many countries.^{2, 126}
{+}
A recent multinational study exposes the scope of the problem: based on standard criteria established by the American College of Chest Physicians, only 59% of surgical patients and 40% of medical patients at risk of venous thromboembolism (VTE) received appropriate preventive treatment.⁵⁷

A review of the efficacy and limitations of current anticoagulant and antiplatelet treatments can provide insight into current practice patterns — and support the pressing need for new approaches to treatment and prevention.⁵

Antiplatelet therapy

Antiplatelet agents play a valuable role in primary and secondary prevention of coronary disease. Clinicians must balance the therapeutic benefits with the risks of bleeding.

Learn more about antiplatelet therapy

Current approaches to antithrombotic therapy

A wide array of preventive measures and acute treatments are available to clinicians.

Learn more about current approaches

Mechanical devices

Mechanical devices, such as compression stockings, are useful for VTE prevention in patients at high risk of bleeding. However, these approaches are not considered as effective as drug therapy.⁵ In patients with atrial fibrillation (AF), implantable devices that occlude the left atrial appendage are currently being investigated; these devices may help to decrease the incidence of stroke.⁴

Learn more about mechanical devices

Anticoagulants

Novel pharmacologic approaches have led to the recent introduction of promising new anticoagulants that can significantly enhance thromboembolism prevention.

Two new agents — rivaroxaban and dabigatran etexilate — were recently approved by the European Union and many countries worldwide.^{251, 267, 269}
{+}
These are the first new classes of oral anticoagulants to be launched since the introduction of warfarin, the first vitamin K antagonist (VKA), in the 1950s.¹⁹⁴ Unlike warfarin, these novel agents are directed against specific coagulation factors. Rivaroxaban targets Factor Xa, whereas dabigatran inhibits thrombin.^{267, 269}

Learn about venous thrombosis (VTE) prevention and the most widely-used anticoagulants for treating

Targeting arterial thrombosis

A diverse array of interventions, including acute and chronic drug therapy, stent placement, and clot extraction, are used to treat coronary atherothrombosis and acute coronary syndrome.

Learn more about anticoagulants

Article references

2 - Moll S, Mackman N. Venous thromboembolism: a need for more public awareness and research into mechanisms. Arterioscler Thromb Vasc Biol. 2008;28(3):367-369.
126 - Lip GY, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol. 2007;6(11):981-993.
57 - Cohen AT, Tapson VF, Bergmann JF, et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-394.
5 - Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46(6):937-954.
4 - Lip GY, Tse HF. Management of atrial fibrillation. Lancet. 2007;370(9587):604-618.
251 - Pradaxa [package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals; 2010.
267 - Summary of product characteristics for Pradaxa. London, England: European Medicines Agency; 2008.
269 - Summary of product characteristics for Xarelto. London, England: European Medicine Agency; 2008.
194 - Friedman RJ. New oral anticoagulants for thromboprophylaxis after elective total hip and knee arthroplasty. Thrombosis. 2010:1-9. Article ID 280731.

American College of Chest Physicians: Multidisciplinary international medical society based in Northbrook, Illinois, USA, that focuses on the treatment and prevention of all diseases of the chest. It has over 16,000 active members with physicians representing all chest medicine disciplines. Publishes the journal Chest.
Venous thromboembolism: A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE. The term encompasses both DVT and PE.
Coagulation factors: Group of plasma protein substances (Factor I to XIII) contained in the plasma, which act together to bring about blood coagulation.
Dabigatran: The active form of the prodrug dabigatran etexilate, an oral direct thrombin inhibitor.
Factor Xa: The activated form of Factor X. It catalyses the conversion of prothrombin to thrombin in conjunction with other cofactors.
Rivaroxaban: Oral, direct Factor Xa inhibitor.
Thrombin: Also called Factor IIa, thrombin performs two functions in the coagulation cascade: activating platelets, and catalysing the conversion of soluble fibrinogen into insoluble fibrin. It is formed from prothrombin by a reaction that is catalysed by Factor Xa.
Vitamin K: An essential cofactor in the carboxylation of glutamic residues on the procoagulant forms of Factors II, VII, IX, and X. This ultimately leads to increased formation of thrombin and fibrin.
Warfarin: A vitamin K antagonist. Most commonly used oral anticoagulant in chronic prevention or treatment of VTE.
Acute coronary syndrome: This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.