21. Antithrombotic Therapy in Venous Thrombosis and Pulmonary Embolism

  1. David J. Moliterno MD3,
  2. Steen Dalby Kristensen MD, DMSc4 and
  3. Raffaele De Caterina MD, PhD5
  1. Marcello Di Nisio MD, PhD1 and
  2. Harry R. Büller MD2

Published Online: 3 OCT 2012

DOI: 10.1002/9781118410875.ch21

Therapeutic Advances in Thrombosis, Second Edition

Therapeutic Advances in Thrombosis, Second Edition

How to Cite

Di Nisio, M. and Büller, H. R. (2012) Antithrombotic Therapy in Venous Thrombosis and Pulmonary Embolism, in Therapeutic Advances in Thrombosis, Second Edition (eds D. J. Moliterno, S. D. Kristensen and R. De Caterina), Blackwell Publishing Ltd., Oxford, UK. doi: 10.1002/9781118410875.ch21

Editor Information

  1. 3

    Department of Internal Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA

  2. 4

    Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark

  3. 5

    G. D'Annunzio University – Chieti, Ospedale SS. Annunziata, Chieti, Italy

Author Information

  1. 1

    Department of Internal Medicine, G. D'Annunzio University – Chieti, Ospedale SS. Annunziata, Chieti, Italy

  2. 2

    Department of Vascular Medicine/Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Publication History

  1. Published Online: 3 OCT 2012
  2. Published Print: 9 NOV 2012

ISBN Information

Print ISBN: 9781405196253

Online ISBN: 9781118410875

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Keywords:

  • Antithrombotic therapy;
  • Anticoagulant;
  • Heparin;
  • Fondaparinux;
  • Dabigatran;
  • Rivaroxaban;
  • Apixaban;
  • Edoxaban;
  • Deep vein thrombosis;
  • Pulmonary embolism

Summary

The antithrombotic therapy for venous thrombosis and pulmonary embolism aims at symptom relief, as well as prevention of short- and long-term complications. The mainstays of initial therapy are unfractionated heparin, low molecular weight heparin (LMWH) or fondaparinux followed by extended anticoagulation with oral vitamin K antagonists (VKAs) at a dose titrated to achieve an international normalized ratio of 2.0–3.0. Thrombolytic therapy is reserved for patients with massive pulmonary embolism. New anticoagulants with a more predictable pharmacologic profile are in an advanced stage of development and show promise relative to VKAs and even for initial LMWH. For venous thrombosis and pulmonary embolism associated with a transient risk factor, anticoagulant treatment is given for 3 months, while for cases without an identifiable cause, anticoagulation is provided for at least 3–6 months. For superficial venous thrombosis, fondaparinux at prophylactic doses appears to be a valid therapeutic option.