Which medications are used in the treatment of venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Anticoagulant inpatient medications should include heparin or a low-molecular-weight heparin (LMWH), followed by the initiation of an oral coumarin derivative. Heparin is administered by bolus dosing, followed by a continuous infusion. The predominant coumarin derivative in clinical use in North America is warfarin sodium.

Apixaban, dabigatran, rivaroxaban, edoxaban, and betrixaban are alternatives to warfarin for prophylaxis or treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE). Apixaban, edoxaban, rivaroxaban, and betrixaban inhibit factor Xa, whereas dabigatran is a direct thrombin inhibitor.

The US Food and Drug Administration (FDA) has approved the thrombolytic agents streptokinase and recombinant tissue-type plasminogen activator (rt-PA) for thrombolytic use in PE. Because antibodies to streptokinase may develop and rt-PA has increasingly been used as the first-choice thrombolytic agent.

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