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Treatment of pulmonary embolism.

Abstract : The treatment of pulmonary embolism is going to be deeply modified by the development of Direct Oral Anticoagulants (DOACs). There are currently three anti-Xa factors (rivaroxaban, apixaban, edoxaban) and one anti-IIa factor (dabigatran) labeled by the FDA and the EMA. All these drugs are direct anticoagulant, orally effective, without the need for adaptation to hemostasis test. As kidney excretion is involved for all of them, they are contra-indicated in patients with severe renal failure (creatinine clearance<30mL/min according to Cockcroft & Gault formula). All the anti-Xa factor drugs are metabolized by liver cytochromes and then contra-indicated in case of liver insufficiency. Of note, the four DOACS have been evaluated in non-inferiority trials, including one open-label trial (the EINSTEIN program with the rivaroxaban). Moreover, two of them (rivaroxaban and apixaban) were evaluated in a single drug approach (provided initial increased doses: 15mg bid during 21days for rivaroxaban and 10mg bid during 7days for apixaban) whereas the two others (edoxaban and dabigatran) were evaluated after at least 5days of parenteral heparin. They were found to be non-inferior to the conventional treatment, but also seem to be associated with a decreased risk of major bleeding, in a quite young and without significant comorbidities population. The risk/benefit ratio of DOACs in specific subgroups deserves prospective validations.
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https://hal.univ-brest.fr/hal-01259804
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Submitted on : Thursday, January 21, 2016 - 8:59:07 AM
Last modification on : Tuesday, September 8, 2020 - 4:34:35 PM

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Hervé Décousus, Patrick Mismetti, Francis Couturaud, Walter Ageno, Rupert Bauersachs. Treatment of pulmonary embolism.. La Presse Médicale, Elsevier Masson, 2015, 44 (12 Pt 2), pp.e393-9. ⟨10.1016/j.lpm.2015.10.008⟩. ⟨hal-01259804⟩

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