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American Journal of Medicine
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American Journal of Medicine
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In addition to the recommendations seen in Figure 7, the ACCP guideline authors state that in patients with the DVT of the leg and no cancer – again, very importantly, no cancer – VKA therapy, usually warfarin, is recommended over LMWH for long-term therapy (Figure 8).[4] For patients with DVT and no cancer who are not treated with a VKA therapy, the authors suggest LMWH over dabigatran or rivaroxaban for long-term therapy (I will clarify that statement in the next Figure).
In patients with DVT of the leg and with cancer, we suggest LMWH over a VKA. In patients with DVT and cancer who are not treated with LMWH, we suggest the VKA over dabigatran or rivaroxaban for long-term therapy.
As an aside, the investigators (including myself) who contributed to writing several of these chapters were limited to the data available at that time; this means that the data for these chapters were assessed and assembled in October 2011, with ultimate publication in February 2012, and so many of the novel aspects of these newer anticoagulants were not known or were just emerging at the time of going to press. 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.