New Oral Anticoagulants In Management Of Deep Venous Thrombosis

Abstract

Deep venous thrombosis is considered a major problem that affect many people, especially who have one or more risk factors that make them more susceptible to acquire VTE. Once the patient is diagnosed as DVT we must start anticoagulation treatment immediately. Ordinary choices of treatment are starting heparinization with UFH or LMWH and overlapping by warfarin (VKA) and monitoring INR titer of the patient. New Oral Anticoagulants are the novel choice in treatment of DVT which have advantages over warfarin in long term treatment of DVT as they do not need monitoring with INR and have shorter half lives that permit the initiation of therapy rapidly and the swift accomplishment of therapeutic level of anticoagulation without the need to overlap with another parenteral anticoagulant. Rivaroxaban, Dabigatran, Apixaban and Edoxaban are considered the main categories of NOACs. Dabigatran is direct thrombin inhibitor , while Rivaroxaban, Apixaban and Edoxaban are direct factor Xa inhibitors . Use of NOACs in treatment of DVT remains limited because of some medical and economic problems in some societies, but some types of NOACs have perfect results in treatment of DVT and even in PE . NOACs have some disadvantages that makes their use not suitable for all patients suffering from DVT, mainly in patients with DVT with cancer, and patients with severe renal or hepatic impairment. Also NOACs have no reliable level assay, that makes their use difficult to some extent.