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Venous thromboembolism: Initiation of anticoagulation (first 10 days)

Authors
Gregory YH Lip, MD, FRCPE, FESC, FACC
Russell D Hull, MBBS, MSc
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Venous thromboembolism (VTE) is comprised of two entities, deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE has significant morbidity and mortality for both the inpatient and outpatient population. The risk of recurrent thrombosis and embolization is highest in the first few days and weeks following diagnosis. Thus, initial anticoagulation during the first few days (ie, 0 to 10 days) is critical in the prevention of recurrence and VTE-related death.

The agents used, timing, duration, and dosing of initial anticoagulation for the treatment of VTE are discussed in this topic. The indications and overview of VTE treatment, as well as long-term (3 to 12 months) and extended (indefinite) anticoagulation for patients with VTE are discussed separately. (See "Overview of the treatment of lower extremity deep vein thrombosis (DVT)", section on 'Patients with contraindications to anticoagulation' and "Venous thromboembolism: Anticoagulation after initial management" and "Rationale and indications for indefinite anticoagulation in patients with venous thromboembolism".)

NOMENCLATURE

For the purposes of discussion in this topic, the following terms apply:

Initial anticoagulation refers to anticoagulant therapy that is administered immediately following diagnosis of acute venous thromboembolism (VTE); it is often given over the first few days (typically from 0 to 10 days) while planning for long term anticoagulation. Long-term anticoagulant therapy is typically administered for a finite period beyond the initial period, usually three to six months and occasionally up to 12 months. Extended anticoagulation usually refers to therapy that is administered indefinitely. (See "Venous thromboembolism: Anticoagulation after initial management" and "Rationale and indications for indefinite anticoagulation in patients with venous thromboembolism".)

Factor Xa and direct thrombin inhibitors have a variety of names including newer/novel oral anticoagulants, non-vitamin K antagonist oral anticoagulants (NOAs, NOACs), direct oral anticoagulants (DOACs), and target-specific oral anticoagulants (TOACs, TSOACs) [1]. Throughout this topic we refer to these agents by their pharmacologic class, factor Xa and direct thrombin inhibitors. (See "Direct oral anticoagulants: Dosing and adverse effects".)

                                

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 10 00:00:00 GMT+00:00 2016.
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