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2015 ; 11
(ä): 271-82
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Current and emerging strategies in the management of venous thromboembolism:
benefit-risk assessment of dabigatran
#MMPMID26064057
Fanola CL
Vasc Health Risk Manag
2015[]; 11
(ä): 271-82
PMID26064057
show ga
Venous thromboembolism (VTE) is a disease state that carries significant
morbidity and mortality, and is a known cause of preventable death in
hospitalized and orthopedic surgical patients. There are many identifiable risk
factors for VTE, yet up to half of VTE incident cases have no identifiable risk
factor and carry a high likelihood of recurrence, which may warrant extended
therapy. For many years, parenteral unfractionated heparin, low-molecular weight
heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the
standard of care in VTE management. However, limitations in current drug therapy
options have led to suboptimal treatment, so there has been a need for
rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and
prophylaxis. Oral VKAs have historically been challenging to use in clinical
practice, with their narrow therapeutic range, unpredictable dose responsiveness,
and many drug-drug and drug-food interactions. As such, there has also been a
need for novel anticoagulant therapies with fewer limitations, which has recently
been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor
available for use in acute and extended treatment of VTE, as well as prophylaxis
in high-risk orthopedic surgical patients. In this review, the risks and overall
benefits of dabigatran in VTE management are addressed, with special emphasis on
clinical trial data and their application to general clinical practice and
special patient populations. Current and emerging therapies in the management of
VTE and monitoring of dabigatran anticoagulant-effect reversal are also
discussed.