Treatment of Venous Thromboembolism with New Oral Anticoagulants According to Patient Risk

Recent developments in antithrombotic therapy have provided us with choices between unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA), and inhibitors against factor Xa or against thrombin for the management of venous thromboembolism. The factors that influence our decision should be efficacy, safety, convenience, and, when there is weak evidence, also patient values and preferences. The available options have largely similar efficacy, the documented exception being LMWH as superior to VKA in patients with active cancer. For the majority of patients we have today strong evidence regarding safety from large randomized trials, but this does not apply to many of the subsets of patients. In this review the choice of treatment is focused on the risks that are known or can be predicted for the individual patient. Three principal decision points on how to tailor the therapy individually are discussed-at diagnosis, for hospitalized patients at the time of discharge and finally after 3 to 6 months.