Comparison of long-term treatment options for venous thromboembolism

Venous thromboembolism (VTE) is a condition that, despite being mostly preventable, is a significant source of morbidity and mortality among hospitalised patients (Popoola et al, 2016). Symptoms include localised pain, swelling and erythema (Andras et al, 2017). Anticoagulation therapy is used to treat symptomatic VTE, since the goal is to prevent reoccurrence, with vitamin K antagonists (VKA) being the prevailing drugs of choice. However, it can be challenging to reach therapeutic levels of VKAs in many patients, and this places them at an increased risk for bleeding (Andras et al, 2017). In order to provide optimal VTE management and prophylaxis, risk-appropriate treatment plans delivered in a patient-centred environment are key (Streiff et al, 2016).

It has been found that nearly 50% of patients forego one or more prescribed doses of VKAs, and patient refusal is most often the reason documented for this (Popoola et al, 2016). Studies have shown that these omitted doses result in avoidable patient harm, as they are related to VTE events (Popoola et al, 2016). Low-molecular-weight heparin (LMWH) may be a possible alternative to VKAs (Andras et al, 2017), as it does not require laboratory tests to establish therapeutic levels, can be used in patients with contraindications to VKAs and minimises the risk of complications associated with bleeding. However, it needs to be established that its safety and efficacy are equivalent to those of VKAs.