Initial heparin therapy followed by oral anticoagulation for 3 to 6 month has been standard therapy for DVT in many clinics. The recently introduced Rivaroxaban, Apixaban are given without initial heparin therapy. So, few doctors are still comfortable giving initial heparin therapy and later oral anticoagulation. The question is about the effectiveness of the high dose of Rivaroxaban or Apixaban given initially? Can resolution of the thrombus in those who received Rivaroxaban and Apixaban can be comparable to that in patients who received the Inj. Heparin?
Bauersachs R et al (Feb 2017) presented Data accumulating on the use of non-VKA oral anticoagulants, such as Rivaroxaban. He is of the opinion that these may provide greater thrombus resolution compared with VKAs. Data from the phase III Rivaroxaban studies discussed showed that a 21-day intensive dosing regimen of Rivaroxaban 15 mg twice daily is effective during the acute treatment phase for VTE, with similar recurrence rates and thrombus resolution to standard anticoagulation.
Probably one may need some more time, studies and availability of the antidote to reverse these drug effects, before he or she can consider recommending the high dose initial therapies of NOACs with more confidence.
References:
1). Bauersachs R1, Koitabashi N. Overview of Current Evidence on
the Impact of the Initial High Dose of the Direct Factor Xa Inhibitor
Rivaroxaban on Thrombus Resolution in the Treatment of Venous Thromboembolism. Int Heart J. 2017 Feb 7;58(1):6-15.
https://www.ncbi.nlm.nih.gov/pubmed/28123163
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