Chapter 28: Thrombosis 2: Treatment

A significant portion of the text is dedicated to the evolution of anticoagulation therapy, highlighting the transition toward direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, edoxaban, and dabigatran. These agents are now established as first-line treatments for deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as for the prevention of systemic embolism in patients with non-valvular atrial fibrillation. The chapter contrasts these newer medications with traditional vitamin K antagonists like warfarin, emphasizing the ongoing necessity of warfarin for patients with mechanical heart valves or antiphospholipid syndrome despite its complex monitoring requirements and potential for food and drug interactions. Detailed attention is given to parenteral options, including unfractionated heparin and low molecular weight heparins (LMWH), outlining their roles in acute hospital care, pregnancy, and cancer-associated venous thromboembolism (VTE). The discussion also addresses critical complications like heparin-induced thrombocytopenia (HIT) and the use of targeted reversal agents such as idarucizumab and andexanet alfa. For arterial conditions, the summary covers the essential role of antiplatelet therapy—including aspirin, P2Y12 inhibitors like clopidogrel and ticagrelor, and glycoprotein IIb/IIIa inhibitors—in the secondary prevention of vascular disease and management of coronary interventions. Additionally, the chapter reviews emergency fibrinolytic therapy and mechanical prophylaxis methods like graduated compression stockings and inferior vena cava (IVC) filters, providing a complete clinical overview of antithrombotic management.