The recent development of several new-class anticoagulants and changes to current prophylactic practices may help to revolutionise the management of venous thromboembolism (VTE), according to Professor Ajay Kakkar, Professor ofSurgical Sciences, Barts and the London School of Medicine and Thrombosis Research Institute.
- Enoxaparin (a subcutaneous low-molecular-weight heparin) – the Exclaim study showed a 44% relative risk reduction in VTE events with extended (five week)
- Enoxaparin prophylaxis (versus standard ten-day prophylaxis), in acutely ill medical patients with reduced mobility.
- Dabigatran (an oral thrombin inhibitor) – a non-inferiority phase III study showed that dabigatran treatment was as safe and effective as enoxaparin treatment for preventing VTEs in patients undergoing total hip replacement.
- RivaroxabaN (an oral Factor Xa inhibitor) – the Record3 phase III study showed that rivaroxaban treatment was superior to enoxaparin treatment for preventing VTEs in patients undergoing knee surgery.
- Apixaban (an oral Factor Xa inhibitor) – a phase II, dose-finding study showed that fixed-dose apixaban monotherapy was safe and effective in patients with deep-vein thrombosis (DVT).
It was also reported that oral contraceptive use in obese women increases VTE air travel risk by 3000%. Compared to the general population, obese women who take oral contraceptives are 30 times more likely to develop a venous thromboembolism (VTE) following air travel, according to a study presented by Professor Harry Büller, Co-Chairman of the Department of Vascular Medicine, Academic Medical Center, Amsterdam. This WHO-endorsed study also identified a number of additional risk-enhancing criteria, which included:
- Sitting in a window seat (two-fold increased risk).
- Being tall (>1.90 m) or short (<1.60 m) (six-fold increased risk);
- Taking a long-haul (>12 hour) rather than a short-haul (<4 hour) flight (sixty-fold increased risk).
