Which medications in the drug class Anticoagulants, Hematologic 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  more...
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Answer

Anticoagulants, Hematologic

Anticoagulant medications prevent further clot deposition. They allow the natural fibrinolytic mechanisms to lyse the existing clot.

Heparin

Heparin augments the activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. The drug prevents the reaccumulation of clot after spontaneous fibrinolysis.

Warfarin (Coumadin, Jantoven)

Warfarin interferes with the hepatic synthesis of vitamin K–dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, PE, and thromboembolic disorders. Tailor the dose to maintain an international normalized ratio (INR) in the range of 2.0-3.0.

Enoxaparin (Lovenox)

Enoxaparin prevents DVT, which may lead to PE in patients undergoing surgery who are at risk for thromboembolic complications. The average duration of treatment is 7-14 days. Enoxaparin enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, it preferentially increases the inhibition of factor Xa. Enoxaparin also has been approved for the treatment of DVT and PE.

Dalteparin (Fragmin)

Dalteparin is indicated for the prevention of DVT, which may lead to PE. It enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, dalteparin preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.

Rivaroxaban (Xarelto)

Rivaroxaban is an oral factor Xa inhibitor that inhibits platelet activation by selectively blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity. It is indicated for a variety of treatment and prophylaxis VTE indications, including risk reduction of stroke and systemic embolism in nonvalvular atrial fibrillation; treatment of DVT and PE; reduction in risk of recurrent DVT and/or PE; prophylaxis of DVT following hip or knee replacement surgery; prophylaxis of VTE in acutely ill medical patients at risk for thromboembolic complications owing to restricted mobility (and who are not at high risk of bleeding); and risk reduction of major CV events with CAD or PAD.

Dabigatran (Pradaxa)

Dabigatran is a direct thrombin inhibitor. Both free and clot-bound thrombin, and thrombin-induced platelet aggregation is inhibited. It is indicated for the treatment of DVT and PE in patients who have been treated with a parenteral anticoagulant for 5-10 days. It is also indicated to reduce the risk of DVT and PE recurrence in patients who have been previously treated.

Apixaban (Eliquis)

Apixaban is a factor Xa inhibitor indicated for treatment of DVT and PE. It is also indicated to reduce the risk of recurrence of DVT and PE in patients who have been previously treated.

Edoxaban (Savaysa)

Edoxaban is a factor Xa inhibitor indicated for treatment of DVT and PE in patients who have been initially treated with a parenteral anticoagulant for 5-10 days.


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