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From The Medical Letter on Drugs and Therapeutics
February 19, 2014

New Oral Anticoagulants for Acute Venous Thromboembolism

JAMA. 2014;311(7):731-732. doi:10.1001/jama.2014.202

Anticoagulants are the drugs of choice for treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE).

Patients with acute VTE are often treated initially with a parenteral anticoagulant such as unfractionated heparin, low molecular weight heparin (LMWH), or fondaparinux (Arixtra, and generics); all are associated with similar rates of mortality, recurrent VTE, and major bleeding. For most patients, the oral vitamin K antagonist warfarin (Coumadin, and others) is started on the same day as parenteral therapy and titrated to maintain an INR between 2 and 3. After ≥5 days, the parenteral anticoagulant is stopped and warfarin is continued as monotherapy, usually for at least 3 months.1