How to treat venous thromboembolism today; 10 years after the introduction of the first direct oral anticoagulant?
Dél-pesti Centrumkórház, Budapest
Venous thromboembolism is the third cardiovascular cause of death in Europe. It affects a number of adults in Hungary equal to the population of a midsize town. Mortality rates are far higher than that of the average of the countries in the European Union, hence detecting and appropriate management of the disease is of paramount public health importance. Due to their acute consequences, tendency to recur and long term complications patients need to be treated with anticoagulants for an adequate time. Traditional treatment has its well-known problems; therefore several direct oral anticoagulants were developed over the last 10 years to gradually replace Vitamin K antagonists. Representatives of this group of drugs are at least as efficacious as warfarin however they are safer if we look at bleeding complications. They offer a more convenient treatment because monitoring of their plasma level is not necessary, and they can be given at fixed doses. There are only a few drug-drug interactions and there are no dietary restrictions. The approval of dabigatran – the first drug in this group – for the treatment of deep vein thrombosis and pulmonary embolism, and prevention of recurrent events in adults was based on a study program consisting of four clinical trials. International guidelines endorse the use of dabigatran and direct oral anticoagulants in preference of Vitamin K antagonists. Present review is to recap the principles of the anticoagulant treatment in this indication and to highlight the role of dabigatran in the therapy by summarizing relevant clinical evidence.