Current Anticoagulant Therapy for Venous Thromboembolism

Abstract

In the past, unfractionated heparin and warfarin requiring dose adjustment have been used as anticoagulants for treatment of venous thromboembolism (VTE) in Japan. These uses are accompanied by several pitfalls, which have led to research and the discovery of new additional groups of anticoagulants: parenteral factor Xa inhibitors, such as fondaparinux, and non-vitamin K antagonist oral anticoagulant: NOAC/direct oral anticoagulant: DOAC, such as edoxaban, rivaroxaban, and apixaban. These new drugs appears to be more effective and safer than conventional anticoagulants, because they are fast-acting, non-inferior to heparin and warfarin in preventing recurrence of VTE, and do not require monitoring, such as the following. NOAC/DOAC could offer new therapeutic options for long-term prevention for recurrence in cases of unprovoked VTE. It would be possible for the initial VTE treatment to start only with NOAC/DOAC, especially for deep vein thrombosis. Moreover, they have the potential to provide more convenient and benefit for cancer patients with VTE: while cancer is most common cause of VTE in Japan. For these reasons, NOAC/DOAC can be used as replacements of unfractionated heparin/warfarin for the initial and long-term treatment for VTE. However, the suitability of these drugs in fragile patients has not been established. Therefore, further studies are required to increase the utility of NOAC/DOAC in the treatment of VTE.