Venous thromboembolism
Deep vein thrombosis and pulmonary embolism. Treatment per CHEST 2022: DOACs in most patients, duration depends on the provoking factor and recurrence risk.
ICD-10 I826 drugs
Also known as: VTE, Deep vein thrombosis, Pulmonary embolism
Drugs used for this condition
- AApixabanFirst line · Direct oral anticoagulants (factor Xa inhibitors)First-line treatment for deep vein thrombosis and pulmonary embolism in outpatients without contraindications per CHEST 2021 and ESC 2019. Loading dose 10 mg twice daily for 7 days, then 5 mg twice daily for up to 6 months. For long-term secondary prevention beyond 6 months, 2.5 mg twice daily is acceptable. DOACs are not used in high-risk antiphospholipid syndrome (triple positivity) – warfarin remains standard there.
- ADabigatranFirst line · Direct thrombin inhibitorDabigatran is used for treatment of deep vein thrombosis and pulmonary embolism and for recurrence prevention. A specific feature of the dabigatran and edoxaban regimens: first 5–10 days of parenteral anticoagulation (LMWH), then a switch to dabigatran 150 mg twice daily. CHEST 2022 lists DOACs as first-line therapy for most VTE patients; warfarin is reserved for antiphospholipid syndrome, severe renal impairment, and active cancer (where direct factor Xa inhibitors are preferred).
- AEnoxaparin sodiumFirst line · Low-molecular-weight heparin (LMWH)In acute deep vein thrombosis and pulmonary embolism, LMWHs are first-line initial anticoagulation with transition to oral anticoagulants (DOACs or warfarin) after 5–10 days. Dose 1 mg/kg subcutaneously twice daily or 1.5 mg/kg once daily. In cancer-associated venous thromboembolism, enoxaparin remains the preferred long-term option for the first 6 months per ASCO 2023.
- ARivaroxabanFirst line · Direct oral anticoagulants (factor Xa inhibitors)First-line treatment of DVT and PE in outpatients without contraindications. Loading 15 mg twice daily for 21 days, then 20 mg once daily for up to 6 months. Long-term secondary prevention: 10 mg once daily. In active cancer, rivaroxaban was studied in SELECT-D; class-level DOAC evidence also comes from Hokusai-VTE Cancer (edoxaban) and ADAM-VTE (apixaban): as effective as LMWH, but GI and genitourinary tumors carry an increased bleeding risk.
- BWarfarinFirst line · Vitamin K antagonist anticoagulantsWarfarin is a well-established anticoagulant for treatment and secondary prevention of DVT and PE. Target INR 2.0–3.0. Duration depends on context: 3 months for provoked VTE, indefinitely for unprovoked or recurrent. DOACs are the preferred alternative, but warfarin remains an option in antiphospholipid syndrome and when DOACs are unavailable.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit