Deep vein thrombosis therapy options available in 2014

Czech version

Authors: D. Karetová ¹; J. Bultas ²
Authors‘ workplace: II. interní klinika – klinika kardiologie a angiologie 1. LF UK a VFN v Praze ¹; Farmakologický ústav, 3. LF UK, Praha ²
Published in: Kardiol Rev Int Med 2014, 16(4): 330-335
Category: Internal Medicine

Overview

The annual incidence of deep vein thrombosis (DVT) together with possible complications – pulmonary embolization – is more than 100 per 100,000 person‑years and has not changed significantly over the last 25 years. Most cases of DVT are treated conservatively with anticoagulants, which can often be given in an outpatient setting. The list of treatment modalities has enlarged recently – new direct oral anticoagulants (NOACs) have been introduced, with practical advantages. At present, it is possible to use the traditional overlap schedule with low molecular weight heparin (LMWH) and warfarin or dabigatran. A more convenient strategy comprises oral treatment only, from the time of diagnosis, with rivaroxaban or apixaban, respectively. Only a minority of well‑selected patients with proximal thrombosis is treated using pharmaco‑ mechanical lysis, in some cases with the necessity of stent implantation into the iliac vein. Surgical removal of the clot is the method of choice only in fresh thrombosis when no antithrombotic drug can be administered. Vena cava filters for the prevention of pulmonary embolization are inserted infrequently, in strictly specified situations.

Keywords:
conservative management of deep vein thrombosis – new oral anticoagulants – rivaroxaban – dabigatran etexilate – apixaban – local thrombolysis – pharmaco‑ mechanical lysis – inferior vena cava filter

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