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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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Abstract

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.

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Acknowledgements

The authors wish to thank Dr. Carlo Botti for the scientific and editorial support. Funding was provided by Bayer SpA.

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Authors and Affiliations

  1. Center for Haemostasis and Thrombosis, Hospital “G. da Saliceto” of Piacenza, Piacenza, Italy

    Davide Imberti

  2. University of Perugia, Perugia, Italy

    Cecilia Becattini

  3. General Hospital of Conegliano and Vittorio Veneto, Vittorio Veneto, Italy

    Enrico Bernardi

  4. Angiology Operating Unit, Azienda Ospedaliera of Padova, Padua, Italy

    Giuseppe Camporese

  5. Fondazione Poliambulanza of Brescia, Brescia, Italy

    Claudio Cuccia

  6. University of Insubria, Varese, Italy

    Francesco Dentali

  7. SIMG, Florence, Italy

    Damiano Paretti

Authors
  1. Davide Imberti
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  2. Cecilia Becattini
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  4. Giuseppe Camporese
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Correspondence to Davide Imberti.

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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.

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Imberti, D., Becattini, C., Bernardi, E. et al. Multidisciplinary approach to the management of patients with pulmonary embolism and deep vein thrombosis: a consensus on diagnosis, traditional therapy and therapy with rivaroxaban. Intern Emerg Med 13, 1037–1049 (2018). https://doi.org/10.1007/s11739-018-1802-5

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  • DOI: https://doi.org/10.1007/s11739-018-1802-5

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