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Treatment of venous thromboembolism: the single-drug approach.

P Prandoni, S Barbar, V Vedovetto, M Milan, L Filippi, E Campello, L Spiezia

An anticoagulant that is effective for both acute and long-term treatment of venous thromboembolism is clearly beneficial and avoids the need for any form of overlapping therapy. Among the emerging oral antithrombotic compounds that have the potential to inhibit either factor Xa (rivaroxaban, apixaban and edoxaban) or factor IIa (dabigatran etexilate), and do not require laboratory monitoring, rivaroxaban and apixaban are the only ones to date for which there is persuasive evidence coming from randomized clinical trials in support of the ‘single‑drug’ approach for the treatment of both patients with deep vein thrombosis and those with hemodynamically stable pulmonary embolism. The oral administration of rivaroxaban (15 mg twice a day for the first 3 weeks, followed by 20 mg once daily for 3–12 months) or apixaban (10 mg twice a day for 7 days, followed by 5 mg twice a day for 6 months) results in a benefit-to-risk ratio that is at least comparable with that provided by conventional treatment with enoxaparin followed by vitamin K antagonists.