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Review
. 2017 Jun 1;24(6):560-565.
doi: 10.5551/jat.RV17005. Epub 2017 Apr 7.

Direct Oral Anticoagulants for the Treatment of Venous Thromboembolism in Japan

Mashio Nakamura  1 , Norikazu Yamada  1 , Masaaki Ito  1
Affiliations
Review

Direct Oral Anticoagulants for the Treatment of Venous Thromboembolism in Japan

Mashio Nakamura et al. J Atheroscler Thromb. .

Abstract

Direct oral anticoagulants (DOACs) were developed to compensate for the demerits of warfarin. In Japan, three factor Xa inhibitors are used for the treatment of venous thromboembolism (VTE): edoxaban, rivaroxaban, and apixaban. Despite problems, such as the inability to monitor their effect and the lack of an antidote, these inhibitors have the same efficacy as conventional treatment with warfarin, and they are associated with a significantly high degree of safety in relation to hemorrhagic complications. East Asians, including Japanese, suffer from hemorrhage more frequently; therefore, DOACs are considered to be highly effective. Although there is no evidence to date, DOACs may be effective in a wide variety of ways, including the possibility that they prevent recurrence over the long term, reduce the length of hospitalization, allow treatment to be started on an outpatient basis, and be effective in cancer patients.

Keywords: Apixaban; Direct oral anticoagulant; Edoxaban; Rivaroxaban.

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Conflict of interest statement

Mashio Nakamura has received remuneration from DAIICHI SANKYO COMPANY, LIMITED, Bayer Yakuhin, Ltd., Pfizer Japan Inc. and Bristol-Myers Squibb K.K.. Norikazu Yamada has received honoraria from Bayer Yakuhin, Ltd. and Bristol-Myers Squibb K.K.. Masaaki Ito has received Scholarship from Bayer Yakuhin, Ltd., Pfizer Japan Inc., Bristol-Myers Squibb K.K., DAIICHI SANKYO COMPANY, LIMITED and Nippon Boehringer Ingelheim Co., Ltd..

Figures

Fig. 1.
Fig. 1.
Structures of the oral factor Xa inhibitors edoxaban, rivaroxaban, and apixaban
Fig. 2.
Fig. 2.
Options for the regimen of direct oral anticoagulants for the initial treatment of venous thromboembolism in Japan Patients at a greater risk of thrombosis are more prone to choosing the dosing regimens in the upper regimen, while patients at a greater risk of bleeding are more prone to choosing the dosing regimens in the lower regimen.
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