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Treatment and Prevention of Venous Thromboembolism in Medical Patients with New Oral Anticoagulant Drugs: Recent Results and Ongoing Studies

Guy Meyer, MD

Several new anticoagulant drugs are currently being developed for the treatment of established venous thromboembolism (VTE) and the prevention of this disorder in medical patients. These drugs are direct inhibitors of Factor Xa or direct thrombin inhibitors; they can be administered orally, have minimal interactions with food and other drugs, and can be administered at fixed dosages without monitoring. They have been tested for the prevention of VTE after major orthopedic surgery, and some have already gained approval for this indication in many countries. Rivaroxaban, dabigatran, apixaban, and edoxaban have been or are currently being tested for the treatment or prevention of VTE in medical patients in large Phase III studies. Rivaroxaban has been proven to be noninferior to standard therapy for the treatment of deep venous thrombosis in the EINSTEIN study, and dabigatran, given after a short course of heparin, has been shown to be noninferior to warfarin for the treatment of VTE in the RE-COVER study. Rivaroxaban and dabigatran have been found to be more effective than placebo for the secondary prevention of VTE in patients who have received anticoagulants for 3–12 months, and dabigatran has been shown to be noninferior to warfarin in similar patient groups. Rivaroxaban is currently being tested for the treatment of acute pulmonary embolism, and dabigatran is being evaluated for the treatment of acute VTE. Studies are evaluating the efficacy and safety of apixaban and edoxaban for the treatment of VTE, and two large trials have recently been completed with apixaban and rivaroxaban in the prevention of VTE in medical patients. Available results and the design of these studies are reviewed in this article. Adv Venous Arterial Thromb 2011;1(3):87–95.

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