Current and emerging strategies in the management of venous thromboembolism

Benefit–risk assessment of dabigatran

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug–drug and drug–food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

Original languageEnglish (US)
Pages (from-to)271-282
Number of pages12
JournalVascular Health and Risk Management
Volume11
DOIs
StatePublished - May 27 2015

Fingerprint

Venous Thromboembolism
Anticoagulants
Vitamin K
Therapeutics
Orthopedics
Antithrombins
Dabigatran
Low Molecular Weight Heparin
Standard of Care
General Practice
Heparin
Cause of Death
Clinical Trials
Morbidity
Recurrence
Drug Therapy
Mortality
Population

Keywords

  • Dabigatran
  • Deep venous thrombosis
  • Novel oral anticoagulants
  • Oral anticoagulation
  • Pulmonary embolism
  • Venous thromboembolism

Cite this

@article{ee02f89f241146c6ac9322a851b1ce1d,
title = "Current and emerging strategies in the management of venous thromboembolism: Benefit–risk assessment of dabigatran",
abstract = "Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug–drug and drug–food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.",
keywords = "Dabigatran, Deep venous thrombosis, Novel oral anticoagulants, Oral anticoagulation, Pulmonary embolism, Venous thromboembolism",
author = "Fanola, {Christina L.}",
year = "2015",
month = "5",
day = "27",
doi = "10.2147/VHRM.S62595",
language = "English (US)",
volume = "11",
pages = "271--282",
journal = "Vascular Health and Risk Management",
issn = "1176-6344",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Current and emerging strategies in the management of venous thromboembolism

T2 - Benefit–risk assessment of dabigatran

AU - Fanola, Christina L.

PY - 2015/5/27

Y1 - 2015/5/27

N2 - Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug–drug and drug–food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

AB - Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug–drug and drug–food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

KW - Dabigatran

KW - Deep venous thrombosis

KW - Novel oral anticoagulants

KW - Oral anticoagulation

KW - Pulmonary embolism

KW - Venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=84936750000&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84936750000&partnerID=8YFLogxK

U2 - 10.2147/VHRM.S62595

DO - 10.2147/VHRM.S62595

M3 - Review article

VL - 11

SP - 271

EP - 282

JO - Vascular Health and Risk Management

JF - Vascular Health and Risk Management

SN - 1176-6344

ER -