From the Guidelines
Therapeutic anticoagulation for more than 3 months is recommended for all patients with pulmonary embolism (PE). When considering the management of PE, it's crucial to prioritize the duration of anticoagulation to minimize the risk of recurrence and mortality while balancing the risk of anticoagulant-related bleeding 1. The decision on the duration of anticoagulation should be individualized, taking into account the patient's risk factors, the presence of cancer, and the risk of anticoagulant-related bleeding.
- For patients with a first PE secondary to a major transient or reversible risk factor, discontinuation of therapeutic oral anticoagulation is recommended after 3 months 1.
- For patients with recurrent venous thromboembolism (VTE) not related to a major transient or reversible risk factor, oral anticoagulant treatment of indefinite duration is recommended 1.
- In patients without cancer, extended oral anticoagulation of indefinite duration should be considered for those with a first episode of PE and no identifiable risk factor, or those with a first episode of PE associated with a persistent risk factor other than antiphospholipid antibody syndrome 1.
- The choice of anticoagulant and the dose should be based on the patient's individual risk factors and preferences, with reduced-dose non-vitamin K antagonist oral anticoagulants (NOACs) such as apixaban (2.5 mg twice daily) or rivaroxaban (10 mg once daily) considered after 6 months of therapeutic anticoagulation 1.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL - Kit Carton Xarelto ® (rivaroxaban) Tablets ... Starter Pack for treatment of deep vein thrombosis and treatment of pulmonary embolism Days 1-21 15mg per tablet, twice daily 42 tablets Days 22-30 20mg per tablet, once daily 9 tablets First 30-day supply The starter pack for pulmonary embolism (PE) has a duration of 30 days, divided into:
- Days 1-21: 15mg twice daily
- Days 22-30: 20mg once daily 2
From the Research
Duration of Starter Pack for PE
The duration of a starter pack for Pulmonary Embolism (PE) treatment is not explicitly stated in the provided studies. However, the studies discuss the treatment options and durations for PE:
- The studies suggest that the initial treatment of PE can be simplified with the use of direct oral anticoagulants (DOACs) such as apixaban, edoxaban, rivaroxaban, or dabigatran 3, 4.
- The treatment duration for PE can vary depending on individual risk factors, but patients are typically recommended to receive continued anticoagulation for 3 months or longer 5, 6.
- Extended anticoagulation with DOACs such as apixaban can reduce the risk of recurrent venous thromboembolism without increasing the rate of major bleeding 7.
- The studies also discuss the use of non-VKA oral anticoagulants, which can be given at fixed doses without the need for routine coagulation monitoring, making them a convenient option for longer-term or extended anticoagulation 6.
Key Points
- Initial treatment of PE can be simplified with DOACs
- Treatment duration can vary depending on individual risk factors
- Extended anticoagulation with DOACs can reduce the risk of recurrent venous thromboembolism
- Non-VKA oral anticoagulants can be given at fixed doses without routine coagulation monitoring