Multidisciplinary approach to the management of patients with pulmonary embolism and deep vein thrombosis: a consensus on diagnosis, traditional therapy and therapy with rivaroxaban
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Despite the availability of updated guidelines for the diagnosis and treatment of venous thromboembolism (VTE), the management of this disorder in clinical practice is often not standardized, given the different degree of compliance with official recommendations by the various involved specialists. The aim of this consensus paper, as a result of a board of experts in thromboembolism, is to define strategies to improve the quality of patients’ care and the efficiency of healthcare resources utilization, by means of: (a) analysis of the guidelines for diagnosis and treatment of VTE; (b) analysis of diagnostic and therapeutic algorithms currently used in clinical practice by different specialists; (c) agreement on a common algorithm for diagnosis and treatment of VTE in different clinical settings; (d) definition of the possible role of the new oral anticoagulant agents (NOAC), such as rivaroxaban, based on their potential benefits for both acute and chronic therapy. The so-called “single drug approach” (as opposed to the traditional heparin/VKA combination), which can be adopted with these drugs, makes anticoagulation more convenient for both patients and healthcare providers, without the need for a close monitoring of the hemocoagulative status, and with a concomitant reduction of length of hospitalization and treatment costs. Among NOACs, in this paper we focused on rivaroxaban only because it was the unique available NOAC in Italy for the treatment of VTE at the time the manuscript was written. Concerning rivaroxaban, the results of two phase III, randomized and controlled trials confirm the non-inferiority of this drug compared to standard therapy (enoxaparin/warfarin) for the treatment of patients with pulmonary embolism (EINSTEIN PE Study) or deep vein thrombosis (EINSTEIN DVT Study) in terms of both efficacy and safety, supporting its use as an effective therapeutic option for these disorders.
KeywordsVenous thromboembolism Anticoagulation Pulmonary embolism EINSTEIN DVT Study EINSTEIN PE Study
The authors wish to thank Dr. Carlo Botti for the scientific and editorial support. Funding was provided by Bayer SpA.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statements on human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Reitsma PH (2015) Genetics in thrombophilia. An update. Haemostaseologie 35(1):47–51Google Scholar
- 7.Thaler J, Pabinger I, Ay C (2015) Anticoagulant treatment of deep vein thrombosis and pulmonary embolism: the present state of the art. Front Cardiovasc Med 2((article 30)):1–7Google Scholar
- 19.Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation 123(16):1788–1830. http://circ.ahajournals.org/content/123/16/1788.long CrossRefGoogle Scholar
- 24.Degli Esposti L et al (2011) Farmacoeconomia e percorsi terapeutici. Farmacoeconomia 12(2):53–59Google Scholar
- 25.NICE TA261 (2012) Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism. http://www.nice.org. Accessed 26 Jan 2018
- 26.NICE CG144 (2012) Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. http://www.nice.org. Accessed 26 Jan 2018
- 28.Prins M, Lensing AW, Bauersachs R et al (2013) Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the Einstein-DVT and PE randomized studies. Thromb J 11(1):21. https://doi.org/10.1186/1477-9560-11-21 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.McLeod E et al. XXIV Congress of the International Society on Thrombosis and Haemostasis; 29th Jun–4th Jul 2013, Amsterdam (The Netherlands): abstract No. OC 02.6Google Scholar