Antithrombotic Management of Venous Thromboembolism: JACC Focus Seminar

Venous thromboembolism (VTE) is a significant public health burden. Management of anticoagulation is the mainstay of treatment for the vast majority of patients. The introduction of 4 direct oral anticoagulants beginning in 2010 has significantly affected selection of anticoagulants for patients with VTE. Treatment of VTE consists of 3 phases: the initial treatment (first 5 to 21 days), primary treatment (first 3 to 6 months), and secondary prevention (after the initial 3 to 6 months). Oral-only anticoagulation strategies are now available, using apixaban or rivaroxaban therapy, beginning in the initial treatment phase. In addition, low-dose anticoagulation with either apixaban or rivaroxaban can be used in the secondary prevention phase for appropriate patients. Use of the direct oral anticoagulants is now supported for many patients with cancer-associated VTE. Appropriate selection and monitoring of anticoagulants remains a critical element of high-quality care for patients with VTE.