Anticoagulant therapy of venous thromboembolic complications: balancing between risks

Lobastov K.V.¹, Sapelkin S.V.^1,2

1) Russian National Research Medical University named after N.I. Pirogov,
2) Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, 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.

KEY WORDS: venous thrombosis, pulmonary embolism, venous thromboembolic complications, recurrence, prevention, anticoagulants.

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