Oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism

Venous thromboembolism (VTE), comprising deep vein thrombosis, pulmonary embolism, or both, is the third most common cardiovascular disorder.

VTE is a potentially fatal yet preventable and treatable condition with the use of anticoagulation therapy.However, physicians and patients are often reluctant to consider long term treatment with vitamin K antagonists owing to the risks of bleeding, the need for regular monitoring, and lifestyle adjustments as long as treatment is continued.

Recently, new oral anticoagulants (rivaroxaban, apixaban, and dabigatran) and antiplatelet agents (acetylsalicylic acid (ASA)) have been evaluated for long term secondary prevention of recurrent VTE in patients at high risk of recurrence. These alternatives may offer a simplified approach to anticoagulation and a better harm profile than VKA. However, before the adoption of new anticoagulants or antiplatelet strategies for long term secondary prevention of VTE in patients with unprovoked VTE, the trade-off between recurrent VTE prevention and bleeding associated with these agents needs to be explored and compared to help doctors determine the optimal management strategy.

The authors incorporate the new information available in the literature and describe the results of their systematic review and meta-analysis in the the efficacy and safety of oral anticoagulants and antiplatement drugs in the secondary prevention of VTE.