[Anticoagulant therapy of venous thromboembolic complications: balancing between risks]. 2017

K V Lobastov, and S V Sapelkin
Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia.

This article is a review of the literature, related to the problem of recurrence of venous thromboembolic complications and the possibilities of their secondary prevention. The problems of determining the rational duration of anticoagulant therapy on the basis of an individual assessment of its benefit and risk are considered. The information on modern prognostic models allowing quantitative assessment of the probability of hemorrhagic and thrombotic events occurrence is presented (Vienna prediction model, DASH, HAS-BLED, stratification according to ACCP 2016). Particular attention is paid to the effectiveness and safety of new oral anticoagulants and acetylsalicylic acid in the context of secondary prevention of deep vein thrombosis and pulmonary embolism. A review and a critical analysis of the EINSTEIN CHOICE study were carried out. The results demonstrated the high efficacy and safety of rivaroxaban 10 and 20 mg in the frame of prolonged therapy of venous thromboembolic complications in patients, who completed the standard 6-12-month course of treatment and who do not need further use therapeutic doses of anticoagulants. The study demonstrated that the use of rivaroxaban in both doses for 12 months is characterized by greater efficacy and a similar frequency of occurrence of large and clinically significant bleeding compared with the intake of 100 mg of acetylsalicylic acid. The authors attempted to determine rational indications for the application of 10 mg of rivaroxaban in the frame of prolonged anticoagulant therapy, which will be possible after making appropriate changes to the official instruction for the drug.

UI MeSH Term Description Entries
D011655 Pulmonary Embolism Blocking of the PULMONARY ARTERY or one of its branches by an EMBOLUS. Pulmonary Thromboembolism,Thromboembolism, Pulmonary,Embolism, Pulmonary,Embolisms, Pulmonary,Pulmonary Embolisms,Pulmonary Thromboembolisms,Thromboembolisms, Pulmonary
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000925 Anticoagulants Agents that prevent BLOOD CLOTTING. Anticoagulant Agent,Anticoagulant Drug,Anticoagulant,Anticoagulant Agents,Anticoagulant Drugs,Anticoagulation Agents,Indirect Thrombin Inhibitors,Agent, Anticoagulant,Agents, Anticoagulant,Agents, Anticoagulation,Drug, Anticoagulant,Drugs, Anticoagulant,Inhibitors, Indirect Thrombin,Thrombin Inhibitors, Indirect
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D054539 Medication Therapy Management Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings. Drug Therapy Management,MEDICARE Prescription Drug Improvement and Modernization Act of 2003,Management, Drug Therapy,Management, Medication Therapy,Therapy Management, Drug,Therapy Management, Medication
D055502 Secondary Prevention The prevention of recurrences or exacerbations of a disease or complications of its therapy. Disease Prevention, Secondary,Early Therapy,Relapse Prevention,Secondary Disease Prevention,Disease Preventions, Secondary,Early Therapies,Prevention, Relapse,Prevention, Secondary,Prevention, Secondary Disease,Preventions, Relapse,Preventions, Secondary,Preventions, Secondary Disease,Relapse Preventions,Secondary Disease Preventions,Secondary Preventions,Therapies, Early,Therapy, Early
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments
D020246 Venous Thrombosis The formation or presence of a blood clot (THROMBUS) within a vein. Deep Vein Thrombosis,Phlebothrombosis,Thrombosis, Deep Vein,Thrombosis, Venous,Deep Venous Thrombosis,Deep-Vein Thrombosis,Deep-Venous Thrombosis,Deep Vein Thromboses,Deep Venous Thromboses,Deep-Vein Thromboses,Deep-Venous Thromboses,Phlebothromboses,Thromboses, Deep Vein,Thromboses, Deep Venous,Thromboses, Deep-Vein,Thromboses, Deep-Venous,Thromboses, Venous,Thrombosis, Deep Venous,Thrombosis, Deep-Vein,Thrombosis, Deep-Venous,Vein Thromboses, Deep,Vein Thrombosis, Deep,Venous Thromboses,Venous Thromboses, Deep,Venous Thrombosis, Deep

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