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Figure 10 comes from the same official ACCP statement as Figures 7 and 8, and states that in addition to being less burdensome to patients, treatment of VTE with one of the novel anticoagulant agents (NOACs), dabigatran or rivaroxaban, may prove to be associated with better clinical outcomes than traditional treatment with LMWH and VKA therapy.[4] Of course since these guidelines were prepared in October 2011, post-marketing studies of safety with the NOACs were not available and so, given the paucity of available data and with new data rapidly emerging, the authors gave a weak recommendation in favor of LMWH and VKA therapy over therapy with dabigatran and rivaroxaban, without making any recommendation favoring one of the NOACs over the other.
The time-restriction on the relevance of these recommendations emphasizes again the importance for clinicians, physicians, nurse practitioners, and physician assistants to remain actively in tune with the literature in this field, because new data and studies are emerging almost weekly concerning these new anticoagulants. Hylek E. Am J Med 2013; published on-line at http://education.amjmed.com/00000.
[4] Kearon C, Akl EA, Comerota AJ, et al; American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-e494S.