Center for Haemostasis and Thrombosis, Hospital "G. da Saliceto" of Piacenza, Piacenza, Italy.
University of Perugia, Perugia, Italy.
Intern Emerg Med. 2018 Oct;13(7):1037-1049. doi: 10.1007/s11739-018-1802-5. Epub 2018 Mar 8.
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.
尽管有更新的静脉血栓栓塞症（VTE）诊断和治疗指南，但由于不同专业医生对这些建议的遵守程度不同，该疾病的临床管理通常并不标准化。这份共识文件是由一组血栓栓塞症专家制定的，旨在通过以下方法来确定提高患者护理质量和医疗资源利用效率的策略：（a）分析 VTE 的诊断和治疗指南；（b）分析不同专业医生目前在临床实践中使用的诊断和治疗算法；（c）就不同临床情况下的 VTE 诊断和治疗的通用算法达成一致；（d）基于新型口服抗凝剂（NOAC），如利伐沙班在急性和慢性治疗中的潜在益处，定义其可能的作用。这些药物的所谓“单药治疗方法”（与传统肝素/VKA 联合治疗相反），可以使患者和医护人员都更加方便地进行抗凝治疗，而无需密切监测血液凝固状态，同时还可以降低住院时间和治疗费用。在这些 NOAC 中，本文仅关注利伐沙班，因为在本文撰写时，它是意大利唯一可用于治疗 VTE 的可用 NOAC。关于利伐沙班，两项 III 期、随机、对照试验的结果证实了该药与标准治疗（依诺肝素/华法林）相比在疗效和安全性方面的非劣效性，支持其在这些疾病中的有效治疗选择。
