Initial treatment of venous thromboembolism

Cecilia Becattini; Giancarlo Agnelli; Joseph Emmerich; Alessandra Bura; Jeffrey I. Weitz

doi:10.1160/TH06-05-0260

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 96(03): 242-250
DOI: 10.1160/TH06-05-0260

Theme Issue Article

Schattauer GmbH

Initial treatment of venous thromboembolism

Authors

Cecilia Becattini

¹Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
Giancarlo Agnelli

¹Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
Joseph Emmerich

²Service de Médecine Vasculaire-HTA, Hôpital Européen Georges Pompidou, Paris, France
Alessandra Bura

²Service de Médecine Vasculaire-HTA, Hôpital Européen Georges Pompidou, Paris, France
Jeffrey I. Weitz

³Departments of Medicine and Biochemistry, McMaster University and Henderson Research Center, Hamilton, Ontario, Canada

Abstract

Summary

Immediate anticoagulant treatment is essential to reduce morbidity and mortality in patients with acute venous thromboembolism (VTE). Currently, rapid anticoagulation can only be achieved with parenteral anticoagulants, such as heparin or low-molecular-weight heparin (LMWH).Weight-adjusted LMWH is the treatment of choice, because it produces predictable anticoagulation and does not require coagulation monitoring. If heparin is used, the activated partial thromboplastin time must be monitored and the heparin dose adjusted to ensure a therapeutic level of anticoagulation. Heparin is recommended for patients with renal impairment and for those at high risk of bleeding. The selective factor Xa inhibitor fondaparinux is a recently introduced alternative to heparin or LMWH for initial VTE treatment. Heparin, LMWH, or fondaparinux should be given for at least five to seven days. Vitamin K antagonists should be initiated on the first day, or as soon as possible, in patients who are candidates for an oral anticoagulant. An oral anticoagulant agent to be used without laboratory monitoring for both acute and long-term treatment of VTE remains an unsolved clinical need in the treatment of VTE.

Keywords

Venous thromboembolism - deep vein thrombosis - pulmonary embolism - heparin - low-molecular-weight heparin - anticoagulants

Full Text

References

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