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Hamostaseologie 2013; 33(03): 218-224
DOI: 10.5482/HAMO-13-02-0005
Review
Schattauer GmbH

Do novel oral anticoagulants do better than standard therapy in the treatment of deep vein thrombosis?

Sind neue orale Antikoagulanzien zur Behandlung der tiefen Venenthrombose besser als die Standard therapie?
M. Brodmann
1   Division of Angiology, Medical University Graz, Austria
› Author Affiliations
Further Information

Publication History

received: 26 February 2013

accepted in revised form: 26 April 2013

Publication Date:
28 December 2017 (online)

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Summary

The focus of DVT treatment is the prevention of recurrence and thrombus migration by treatment with anticoagulants. The aim is to improve outcomes by reducing clot burden and by preventing thrombus propagation, in order to prevent PE and the development of long-term complication. Actually, initial therapy is parenteral anticoagulation, mainly with low molecular weight heparin followed by a vitamin K antagonist (VKA) for triggered and idiopathic DVT. The long term treatment suggestion with a VKA is for sure the most challenging therapeutic scenario, showing all the disadvantages of VKA especially in the onset phase when therapeutic levels of VKA are difficult to achieve.

The difference between VKAs and NOACs is the fact, that NOACs target a specific factor in the coagulation cascade. At time now two pathways have been chosen for treatment options, the direct inhibition of active sites of thrombin and factor Xa. Routine monitoring is not required and the drugs can be administered in fixed doses, which should increase patient adherence to long term treatment.

At time now, four novel anticoagulants are called to be options for DVT treatment. Rivaroxaban, apixaban and edoxaban are direct FXa inhibitors, whereas dabigtran etexilate is a direct thrombin inhibitor.

Zusammenfassung

Der Fokus der TVT-Therapie ist die Prevention des Rezidivereignisses und die Migration der Thromben. Das Ziel ist es den Outcome durch die Reduktion der Thrombusmasse und der Verhinderung der Thrombenmigration zu verbessern. So sollen Akut-und Langzeitfolgen verhindert werden. Zum gegenwärtigen Zeitpunkt besteht die Initialtherapie aus parenteraler Antikoagulation, in der Regel niedermolekulares Heparin, gefolgt von oraler Antikoagulation mit einem Vitamin-K-Antagonisten (VKA) für TVT in Risikosituation und idiopathischer TVT. Die Langzeittherapie der TVT mit VKA ist sicherlich die größte therapeutische Herausforderung, da sie alle Nachteile der VKAs aufzeigt, vor allem zu Beginn der Therapie mit der Problematik die therapeutischen Zielwerte zu erreichen.

Der Unterschied zwischen VKAs und NOACs (neuen oralen Antikoagulanzien) ist die Tatsache, dass NOACs einen spezifischen Angriffspunkt in der Gerinnungskaskade aufweisen. Zurzeit gibt es zwei Pfade, die zur Therapieoption gewählt wurden: die direkte Inhibition von Thrombin und Faktor Xa. Routinemonitoring ist nicht nötig und die Medikamente können in fixen Dosen verabreicht werden, was die Patienten-Compliance vor allem in der Langzeittherapie verstärken soll. Zurzeit gibt es vier neue Antikoagulanzien als Therapieoption der TVT: Rivaroxaban, apixaban sind Faktor-Xa-Inhibitoren, Dabigatran ist ein direkter Thrombininhibitor.

Keywords

Deep vein thrombosis - DVT - vitamin K antagonist - VKA - novel oral anticoagulants - NOACs

Schlüsselwörter

Tiefe Venenthrombose - TVT - Vitamin-K-Antagonisten - neue orale Antikoagulanzien
 

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