Low-molecular-weight heparin and fondaparinux have replaced unfractionated heparin for initial VTE treatment, and new oral anticoagulants are emerging as effective replacements for warfarin.
This review highlights the transition from unfractionated heparin to low-molecular-weight heparin and fondaparinux for initial VTE treatment, and the anticipated shift towards new oral anticoagulants for long-term management.
Anticoagulant therapy with unfractionated heparin (UFH) followed by warfarin prevents thrombus extension, reduces the risk of recurrent thrombosis and prevents death in patients with venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) has replaced UFH as the preferred initial anticoagulant therapy for VTE because it is as effective and safe as UFH, but does not require laboratory monitoring and is less likely to cause immune thrombocytopenia and osteoporosis. More recently, fondaparinux has been shown to be an effective and safe alternative to LMWH and several new parenteral anticoagulants are being evaluated. The most important unmet need in the anticoagulant management of VTE is a replacement for warfarin. New oral anticoagulants that selectively target individual steps in the coagulation cascade have been shown to be effective for the long-term treatment of VTE in Phase II and III trials and are likely to become available in the near future.
McRae et al. (Fri,) conducted a review in venous thromboembolism (VTE). Anticoagulant therapy (LMWH, fondaparinux, new oral anticoagulants) vs. Unfractionated heparin (UFH) and warfarin was evaluated. Low-molecular-weight heparin and fondaparinux have replaced unfractionated heparin for initial VTE treatment, and new oral anticoagulants are emerging as effective replacements for warfarin.