2022 Volume 33 Issue 1 Pages 7-14
The Japanese guidelines for diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis, were published in 2004, and were revised twice for these 18 years. The treatments for venous thromboembolism (VTE) have been changed in Japan. Anticoagulant therapy is basic treatment and especially direct oral anticoagulants (DOAC) are now endorsed as first-line treatment. Edoxaban, rivaroxaban and apixaban are approved for VTE treatment in Japan and are direct factor Xa inhibitors. The 3 drugs have quick action, and can be administered with fixed doses without frequent laboratory monitoring. DOACs have drug-drug interactions mechanism that consists of P-glycoprotein transporter and CYP3A4-type cytochrome P450. Some DOACs affect the values of coagulation assays for the laboratory examination of inherited thrombophilia factors. The effects of DOACs are evaluated by prothrombin time and activated thromboplastin time in consideration of the dosing time. DOAC is not recommended in patients with VTE and with active gastrointestinal or genitourinary cancer because of a bleeding risk. DOAC should not be applied in patient with very high body weight, and is contraindicated in patient with VTE and antiphospholipid syndrome. It is important to learn some characteristics and special circumstances requiring careful consideration for DOAC when treating VTE.
