Venous thromboembolism: current management

Anticoagulation is indicated in most cases of venous thromboembolism.Monotherapy with rivaroxaban or apixaban is the preferred option for most adults with acute venous thromboembolism.There are no recommended dose reductions for rivaroxaban or apixaban in venous thromboembolism, unlike for atrial fibrillation.The initial duration of anticoagulation is usually three months.Extended treatment with low-dose rivaroxaban or apixaban is effective in preventing recurrence in patients with a continuing increased risk of thromboembolism.Both drugs have low rates of major bleeding. Venous thromboembolism: current managementon the risk of recurrent venous thromboembolism and therefore on determining the duration of anticoagulation.It is reasonable to test for the antiphospholipid antibody syndrome in patients with unprovoked venous thromboembolism who are under 45 years of age.Drug interactions with direct oral anticoagulants are infrequent.However drugs that significantly alter the function of P-glycoprotein (including azole antifungals, rifampicin, amiodarone or quinidine) or cytochrome P450 3A4 (including HIV protease inhibitors, clarithromycin, carbamazepine and rifampicin) 9,10 may influence their anticoagulant effect.Seek a specialist opinion for patients taking any of these medicines. Initial anticoagulationMost patients can be started on monotherapy with rivaroxaban or apixaban without the use of parenteral anticoagulant therapy.After an initial period of more intense oral anticoagulation, therapy is reduced to maintenance dosing (see Table 1).