Prevention and treatment of thromboembolism in thrombophilic patients

Haema 2014; 5(1):41-53

by Fotios I. Girtovitis

Blood Centre, General University Hospital ΑHΕPΑ, Thessaloniki, Greece

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Deep vein thrombosis and pulmonary embolism are two manifestations of the same disease, namely venous thromboembolism (VTE). Venous thromboembolism is a common disease with an annual incidence of 1 per 1000 person. A serious complication of VTE is recurrent, which is fatal in 4 to 10% of patients. In the majority of the patients recurrence can be prevented by appropriated antithrombotic treatment. The prevention of VTE is divided into primary and secondary. As primary thromboprophylaxis is the use of anticoagulation in patients to prevent venous thromboembolism in those that are considered to be at high risk of developing thrombosis (surgery, long-distance travelers, chronically immobilized patients, etc.) but have not previously had VTE. Secondary prophylaxis is applicable in patients who already have undergone an episode so that it does not reoccur. Patients with deep vein thrombosis or non-massive pulmonary embolism are usually started on parenteral administration of heparin or fondaparinux followed by vitamin K antagonists. Recently a new oral direct Xa inhibitor, rivaroxaban is licensed for the initial treatment of VTE as well as the long-term prevention of recurrence. The duration of anticoagulation should be at least 3 months, anticoagulation can be stopped in patients with a VTE provoked by a transient risk factor including surgery, trauma or pregnancy. Patients with unpro- voked VTE are at higher risk of recurrence and prolonged anticoagulation is recommended.