Management of antithrombotic therapy in gray areas of venous thromboembolism: a Delphi consensus panel
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Management of antithrombotic therapy in gray areas of venous thromboembolism: a Delphi consensus panel Giovanni Barillari1 · Cristiano Bortoluzzi2 · Mauro Giorgi3 · Rossana Orabona4 · Edoarda Pacetti5 · Edoardo Sciatti6 · Marco Zaffaroni7 · Francesco Dentali8 Received: 30 December 2019 / Accepted: 19 February 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract For some years now, direct-acting oral anticoagulants (DOACs) have entered the clinical practice for stroke prevention in non-valvular atrial fibrillation (NVAF) or for prevention and treatment of venous thromboembolism (VTE). However, there is uncertainty on DOACs’ use in some clinical scenarios that are not fully explored by clinical trials, but commonly encountered in the real world. We report a Delphi Consensus on DOAC use in VTE patients. The consensus dealt with seven main topics: (1) clinical superiority of DOACs compared to VKAs; (2) therapeutic options for patients with intermediate risk PE; (3) therapeutic management of patients with deep vein thrombosis (DVT); (4) DOACs’ role in oncological patients with VTE; (5) role of the reversal agent; (6) safety of low doses of DOACs in VTE patients; (7) DOACs long-term therapy (more than 12 months) in VTE patients; Forty-six physicians (cardiologists, internists, angiologists, oncologists, hematologists, and geriatricians) from Italy expressed their level of agreement on each statement by using a five-point Likert scale (1: strongly disagree, 2: disagree, 3: somewhat agree, 4: agree, 5: strongly agree). Votes 1–2 were considered as disagreement, while votes 3–5 as agreement. For each statement an agreement of ≥ 66% among the respondents was considered consensus. A brief discussion about the results for each topic is also reported. Keywords Consensus · Delphi · Direct oral anticoagulants · Venous thromboembolism · Vitamin K antagonists · DOAC · NOAC · Warfarin · Pulmonary embolism · Deep vein thrombosis
Introduction * Francesco Dentali Francesco.dentali@asst‑settelaghi.it 1
Hemorrhagic and Thrombotic Diseases, Santa Maria Della Misericordia University Hospital, Udine, Italy
2
Internal Medicine Unit, SS. Giovanni e Paolo Hospital, Venezia, Italy
3
University Cardiology Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
4
Department of Obstetrics and Gynecology, ASST Spedali Civili and University, Brescia, Italy
5
Internal Medicine Unit, ASL5 Spezzino, La Spezia, Italy
6
Cardiology Unit, ASST Spedali Civili and University, Brescia, Italy
7
Internal Medicine Unit, ASST Monza, San Gerardo Hospital, Monza, MB, Italy
8
Department of Medicine and Surgery, Insubria University, Varese, Italy
Venous thromboembolism (VTE) is a common disease, occurring either as deep vein thrombosis (DVT) or as pulmonary embolism (PE). It is associated with high risk for recurrence, death and late sequelae, determining notable health-care costs. Anticoagulant agents are the mainstay of treatment. For some years now, fixed-dose direct-acting oral anticoa
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