New Trends in Anticoagulation Therapy

Abstract

Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE. Trends in thromboprophylaxis include extended duration low-dose direct oral anticoagulants to prevent VTE in high-risk patients.

Keywords: Anticoagulation; Deep venous thrombosis; Direct oral anticoagulants; Perioperative bridging; VTE chemoprophylaxis; VTE extended therapy; Venous thromboembolism.

Figure 1

In the event of clinical equipoise regarding selection of VKAs or DOACs for the treatment of VTE, the SAMe-TT₂R₂ score can be utilized to predict individuals likely to have adverse events, VTE recurrence an poor time in therapeutic range with VKA treatment. *medical co-morbidities include diabetes, hypertension, renal disease, hepatic disease, pulmonary disease, congestive heart failure, coronary artery disease, peripheral vascular disease or previous stroke.

Figure 2

In women with first time unprovoked VTE, the HERDOO2 score can identify those that are at low risk of recurrent VTE after initial standard anticoagulant therapy and can safely stop anticoagulation.