From the Guidelines
For patients with deep vein thrombosis (DVT) and no cancer, dabigatran, rivaroxaban, apixaban, or edoxaban are suggested over vitamin K antagonist (VKA) therapy as long-term anticoagulant therapy. The choice of anticoagulant depends on various patient factors, including renal function, cancer status, pregnancy, cost considerations, and bleeding risk 1.
Key Considerations
- For DVT and no cancer, direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, or edoxaban are preferred over VKA therapy due to their ease of use and lower risk of bleeding complications 1.
- Low molecular weight heparins (LMWHs) like enoxaparin are commonly used, especially initially or in patients with cancer, pregnancy, or renal impairment 1.
- Traditional warfarin remains an option but requires more monitoring, with a target INR of 2-3 1.
- Treatment duration is typically 3-6 months for provoked DVT and at least 6-12 months or indefinite for unprovoked DVT 1.
Patient-Specific Factors
- Renal function: DOACs may not be suitable for patients with severe renal impairment, and dose adjustments may be necessary 1.
- Cancer status: LMWH is preferred over VKA therapy in patients with cancer-associated thrombosis 1.
- Pregnancy: LMWH is commonly used in pregnant patients due to its safety profile 1.
- Cost considerations and bleeding risk: These factors should be taken into account when choosing an anticoagulant, with DOACs often being more convenient but also more expensive than traditional warfarin 1.
From the FDA Drug Label
Both studies were randomized, parallel-group, double-blind trials in patients with symptomatic proximal DVT and/or symptomatic PE. Patients with an objectively confirmed symptomatic DVT and/or PE were randomized to treatment with apixaban 10 mg twice daily orally for 7 days followed by apixaban 5 mg twice daily orally for 6 months, or enoxaparin 1 mg/kg twice daily subcutaneously for at least 5 days (until INR ≥2) followed by warfarin (target INR range 2.0-3. 0) orally for 6 months. The anticoagulant given in DVT is:
- Apixaban: 10 mg twice daily orally for 7 days followed by 5 mg twice daily orally for 6 months
- Enoxaparin: 1 mg/kg twice daily subcutaneously for at least 5 days (until INR ≥2) followed by
- Warfarin: (target INR range 2.0-3.0) orally for 6 months 2
From the Research
Anticoagulants Used in DVT Treatment
- Unfractionated heparin (UFH) is commonly used as an initial treatment for deep vein thrombosis (DVT) 3
- Low-molecular-weight heparin (LMWH) is also effective and safe for DVT treatment, with advantages including less-frequent dosing and elimination of the need for monitoring 3, 4
- Warfarin is often used as an oral anticoagulant for long-term treatment of DVT 3
- Direct oral anticoagulants (DOACs) are also used for acute VTE treatment and are as effective as conventional therapy with LMWH and vitamin K antagonists 5
- Enoxaparin is a specific type of LMWH that has been shown to be effective in treating DVT with or without pulmonary embolism 6
Treatment Duration and Patient Risk Stratification
- The optimal duration of anticoagulant therapy after DVT depends on an individual patient's potential risk for recurrence or treatment-associated complications 3
- Patients are often risk stratified based on clinical characteristics, including the location of thromboemboli, presence of cancer, and thrombophilic conditions 3, 7
- High-risk patients may receive long-term anticoagulation, while low-risk patients may receive short-term anticoagulation 3, 7
- The presence of antiphospholipid antibodies and other thrombophilic states may favor more prolonged therapy 7