hematology and oncology
Overview of Thrombotic Disorders
Treatment of Thrombotic Disorders
Treatment is summarized elsewhere in THE MANUAL specific to the location of the thrombus. ( Treatment references ). For patients who can be treated as outpatients, direct oral anticoagulants (DOACs) or DOACs includefactor Xainhibitors (rivaroxaban,apixaban,edoxaban) and the directthrombininhibitordabigatran. Unlikewarfarin, DOACs do not require regular laboratory monitoring, and some of these medications (apixaban,rivaroxaban) can be used in acute treatment without initial parenteral anticoagulation. In contrast towarfarin, DOACs have fewer drug-drug interactions and their effectiveness is not influenced by diet. inhibitors) as well as non-specific prohemostatic agents such as prothrombin complex concentrates which contain factors VII, IX, X, and prothrombin ( Treatment references ). A major current disadvantage of DOACs is their expense. 1.Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report [published correction appears inChest2022 Jul;162(1):269].Chest2021;160(6):e545-e608. doi:10.1016/j.chest.2021.07.055 2.Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.Blood Adv2020;4(19):4693-4738. doi:10.1182/bloodadvances.2020001830 3.National Institute on Health and Care Excellence (NICE): Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline [NG 158]. March 26, 2020. 4.Cuker A, Burnett A, Triller D, et al: Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum.Am J Hematol94:697–709, 2019. 5Frontera JA, Lewin JJ 3rd, Rabinstein AA, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine.Neurocrit Care. 2016;24(1):6-46. doi:10.1007/s12028-015-0222-x 