Direct oral anticoagulants in the treatment of pulmonary embolism

Objective: The objective of this review is to examine the management strategies for pulmonary embolism (PE) with an emphasis of the role of direct oral anticoagulants (DOACs). Methods: PubMed was searched to identify relevant journal articles published through April 2017. Additional references were...

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Bibliographic Details
Published in:Current medical research and opinion Vol. 34; no. 1; pp. 131 - 140
Main Authors: Eldredge, Joanna B., Spyropoulos, Alex C.
Format: Journal Article
Language:English
Published: England Taylor & Francis 02.01.2018
Subjects:
Administration, Oral
Anticoagulants - therapeutic use
deep vein thrombosis
direct oral anticoagulants
Factor Xa Inhibitors - therapeutic use
Heparin - therapeutic use
Humans
Pulmonary embolism
Pulmonary Embolism - drug therapy
Risk Factors
treatment
venous thromboembolism
Pulmonary embolism
direct oral anticoagulants
treatment
deep vein thrombosis
venous thromboembolism
ISSN:0300-7995, 1473-4877, 1473-4877
Online Access:Get full text
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Summary:Objective: The objective of this review is to examine the management strategies for pulmonary embolism (PE) with an emphasis of the role of direct oral anticoagulants (DOACs). Methods: PubMed was searched to identify relevant journal articles published through April 2017. Additional references were obtained from articles discovered during the database search. Results: Initial heparinization followed by long-term anticoagulation with vitamin K antagonists has been considered the mainstay for the treatment of PE. However, DOACs now offer comparably effective and potentially safer alternatives for both acute and long-term treatment of PE using a monotherapy approach without the need for initial heparinization for rivaroxaban or apixaban. Advantages to using DOACs include oral availability, rapid onset of action, minimal drug and food interactions, predictable pharmacokinetics, and lack of need for routine monitoring. Limitations of using these agents include a limited availability of assays to quickly and efficiently measure their anticoagulant effects and the lack of widely available reversal agents for the direct oral factor Xa inhibitors; although idarucizumab has recently been approved for the reversal of dabigatran's anticoagulant effects. Conclusions: Advantages to using DOACs render them an attractive alternative to conventional therapy in PE treatment that may simplify acute and long-term treatment paradigms, improve patient outcomes, and increase patient compliance. However, questions remain pertaining to the use of DOACs in PE patients with high-risk features and in cancer patients and fragile populations. Clinical studies are under way to address many of these issues.
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ISSN:0300-7995
1473-4877
1473-4877
DOI:10.1080/03007995.2017.1364227