New trends in the management of thromboembolism

Mark Crowther

Related McMaster Perspective episodes

Sonia Anand, Roman Jaeschke. Peripheral artery disease. Part 1: General management and COMPASS. McMaster Textbook of Internal Medicine.,peripheral-artery-disease-part-1-general-management-and-compass. Published August 8, 2018.
Sonia Anand, Roman Jaeschke. Peripheral artery disease. Part 2: COMPASS implications. McMaster Textbook of Internal Medicine.,peripheral-artery-disease-part-2-compass-implications. Published September 26, 2018.

What are some of the new trends in the management of thromboembolism?

Mark Crowther, MD: There is a whole bunch of new things going on, and I have mentioned one of them already: Recent evidence that one of factor Xa inhibitors is as effective as low-molecular-weight heparin for the long-term secondary prevention of venous thromboembolism in patients with cancer-associated thrombosis [see Anticoagulation in patients with cancer and AF after DVT]. The approval and widespread availability of idarucizumab to reverse the antithrombotic effect of dabigatran. More recently, just last Friday [the video was recorded on May 11, 2018], the approval in the United States of andexanet for the reversal of Xa inhibitors. But it comes with a very large cost and that is going to influence whether or not that drug is available and used.

Thrombosis is an area which is continuously evolving and there is all kinds of new information. One of the things that we learned in the last year, for example, is that rivaroxaban used in a very low dose based on the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) study may be useful to prevent peripheral vascular disease progression, which is a completely new area for antithrombotics to have gone into [see Peripheral artery disease. Part 2: COMPASS implications].

As time passes, I suspect we will continue to see new and exciting research in this area that will influence what type of antithrombotics we use and in which patients we use them.

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