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Internal and Emergency Medicine

, Volume 13, Issue 7, pp 1037–1049 | Cite as

Multidisciplinary approach to the management of patients with pulmonary embolism and deep vein thrombosis: a consensus on diagnosis, traditional therapy and therapy with rivaroxaban

  • Davide Imberti
  • Cecilia Becattini
  • Enrico Bernardi
  • Giuseppe Camporese
  • Claudio Cuccia
  • Francesco Dentali
  • Damiano Paretti
IM - ORIGINAL

Abstract

Despite the availability of updated guidelines for the diagnosis and treatment of venous thromboembolism (VTE), the management of this disorder in clinical practice is often not standardized, given the different degree of compliance with official recommendations by the various involved specialists. The aim of this consensus paper, as a result of a board of experts in thromboembolism, is to define strategies to improve the quality of patients’ care and the efficiency of healthcare resources utilization, by means of: (a) analysis of the guidelines for diagnosis and treatment of VTE; (b) analysis of diagnostic and therapeutic algorithms currently used in clinical practice by different specialists; (c) agreement on a common algorithm for diagnosis and treatment of VTE in different clinical settings; (d) definition of the possible role of the new oral anticoagulant agents (NOAC), such as rivaroxaban, based on their potential benefits for both acute and chronic therapy. The so-called “single drug approach” (as opposed to the traditional heparin/VKA combination), which can be adopted with these drugs, makes anticoagulation more convenient for both patients and healthcare providers, without the need for a close monitoring of the hemocoagulative status, and with a concomitant reduction of length of hospitalization and treatment costs. Among NOACs, in this paper we focused on rivaroxaban only because it was the unique available NOAC in Italy for the treatment of VTE at the time the manuscript was written. Concerning rivaroxaban, the results of two phase III, randomized and controlled trials confirm the non-inferiority of this drug compared to standard therapy (enoxaparin/warfarin) for the treatment of patients with pulmonary embolism (EINSTEIN PE Study) or deep vein thrombosis (EINSTEIN DVT Study) in terms of both efficacy and safety, supporting its use as an effective therapeutic option for these disorders.

Keywords

Venous thromboembolism Anticoagulation Pulmonary embolism EINSTEIN DVT Study EINSTEIN PE Study 

Notes

Acknowledgements

The authors wish to thank Dr. Carlo Botti for the scientific and editorial support. Funding was provided by Bayer SpA.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statements on human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Center for Haemostasis and Thrombosis, Hospital “G. da Saliceto” of PiacenzaPiacenzaItaly
  2. 2.University of PerugiaPerugiaItaly
  3. 3.General Hospital of Conegliano and Vittorio VenetoVittorio VenetoItaly
  4. 4.Angiology Operating UnitAzienda Ospedaliera of PadovaPaduaItaly
  5. 5.Fondazione Poliambulanza of BresciaBresciaItaly
  6. 6.University of InsubriaVareseItaly
  7. 7.SIMGFlorenceItaly

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