Desired Therapeutic Outcomes

The goal of VTE treatment is to prevent short-and long-term complications of the disease. In the short term (i.e., the first few days to 6 months), the aim of therapy is to prevent propagation or local extension of the clot, embolization, and death. In the long term (i.e., more than 6 months after the first event), the aim of therapy is to prevent

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complications, such as PTS, pulmonary hypertension, and recurrent VTE. ' General Treatment Principles

Anticoagulant drugs are considered the mainstay of therapy for patients with VTE,

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and the therapeutic strategies for DVT and PE are essentially identical. ' In the absence of contraindications, the treatment of VTE should initially include a rapid-acting anticoagulant (e.g., UFH, LMWH, or fondaparinux) overlapped with warfarin for at least 5 days and until the patient's INR is greater than 2. Anticoagulation therapy should be continued for a minimum of 3 months. However, the duration of anticoagulation therapy should be based on the patient's risk of VTE recurrence and ma jor bleeding. The treatment of VTE can be divided into acute, subacute, and chronic phases (Fig. 10-5).23,24 The acute treatment phase of VTE is typically accomplished by administering a fast-acting parenteral anticoagulant (Table 10-3). The subacute and chronic phase treatments of VTE are usually accomplished using oral anticoagulant

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agents, such as warfarin. ' In certain populations, such as patients with cancer and women who are pregnant, the LMWHs are the preferred agents during subacute and

chronic treatment phases. In the last decade, several novel anticoagulants, such as direct thrombin inhibitors (DTIs) and factor Xa inhibitors have emerged as potential alternatives for the acute, subacute, and chronic phases of treatment. As data from clinical trials using these new agents in VTE treatment continue to emerge, their role

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in clinical practice will be better understood.

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