NOACs for the treatment and prevention of recurrent VTE
Treatment and prevention of recurrent VTE depends on local policy, but the traditional approach is LMWH followed by VKA. However, this regimen has challenges for both patients and HCPs, including the need for daily injections in the initial LMWH treatment period1 and limitations with the use of VKA.2,3 These include a narrow therapeutic window, numerous food and drug interactions and inconveniences for patients, as summarised below.2,3
Challenges for physicians and patients associated with the use of VKA
[Reference for figure: 3. Van Es J et al. J Thromb Haemost. 2011; 9 Suppl 1: 265–274]
NOACs provide simple oral regimens for the treatment and prevention of recurrent VTE and their use is now supported in favour of LMWH/VKA by international guidelines for some patients in which they are indicated e.g., non-cancer patients with proximal DVT.1,4 NOACs have been shown to reduce the treatment burden compared with VKAs, including offering shorter time to discharge from hospital in acute VTE5 and enabling outpatient treatment of stable, low-risk patients.6 Patients receiving NOACs have also reported higher treatment satisfaction compared with those on VKA.7–10
A further advantage of selected NOACs, apixaban and rivaroxaban, is that they don’t require initial treatment with LMWH, making them suitable for initiation in primary care.11,12 Apixaban and rivaroxaban offer a useful oral single drug approach, allowing patients to start and continue on the same therapy for as long as required, based on their individual risks.11,12 Details of the dosing regimens for each NOAC are shown below.11–14
The duration of overall therapy should be individualised after careful assessment of the treatment against the risk for bleeding.
Please refer to the individual NOAC SmPC for full dosing recommendations.
*Short duration of therapy (at least 3 months) should be based on transient risk factors (e.g. recent surgery, trauma, immobilisation)
[References for image: 11. Apixaban Summary of Product Characteristics. Accessed August 2019. Available at: www.medicines.org.uk/emc/product/2878/smpc. 12. Rivaroxaban Summary of Product Characteristics. Accessed August 2019. Available at: www.medicines.org.uk/emc/product/2793/smpc. 13. Dabigatran Summary of Product Characteristics. Accessed August 2019. Available at: www.medicines.org.uk/emc/product/4703/smpc. 14. Edoxaban Summary of Product Characteristics. Accessed August 2019. Available at: www.medicines.org.uk/emc/product/6906/smpc.]
Click here to view ELIQUIS (apixaban) prescribing and adverse event reporting information.
BD = Twice Daily CrCl = Creatinine Clearance HCP = Health Care Professional LMWH = Low Molecular Weight Heparin NOAC = Non-vitamin K antagonist Oral Anticoagulant OD = Once Daily VKA = Vitamin K Antagonist VTE = Venous Thromboembolism
- Mazzolai L et al. Eur Heart J 2018; 39: 4208–4218.
- Kirchhof P et al. Eur Heart J 2016; 37: 2893–2962.
- Van Es J et al. J Thromb Haemost. 2011; 9 Suppl 1: 265–274.
- Kearon C et al. Chest 2016; 149: 315‒352.
- Basto AN et al. J Thromb Thrombolysis 2018; 45: 51–55.
- Nakamura M et al. Ann Vasc Dis 2017; 10: 92–98.
- Brekelmans MPA, et al. Neth J Med 2017;75:50–55.
- Willich SN et al. Value Health 2014; 17: A496.
- Prins MH et al. Thromb Res 2015; 135: 281–288.
- Keita I et al. Patient Prefer Adher 2017; 11: 1625–1634.
- Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc. Accessed August 2019.
- Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc. Accessed August 2019.
- Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc. Accessed August 2019.
- Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed August 2019.
Job code: 432UK1900506-01
Date of preparation: September 2019