Optimization of anticoagulation therapy for venous thromboembolism

Sukovatykh B.S.¹, Mikhin V.P.¹, Belikov L.N.², Chernyatina M.A.¹, Gladchenko M.P.¹, Savchuk O.F.²

1) Kursk State Medical University
2) Municipal Clinical Hospital of Emergency Medical Care, Kursk, Russia

Objective: To optimize anticoagulation therapy for venous thromboembolism by means of dabigatran etexilate.

Materials and methods. From 2006 to 2012, within the framework of the international trials RE-COVER and RE-COVER II aimed at evaluating efficacy and safety of dabigatran etexilate compared to warfarin, a total of 95 patients meeting the inclusion and exclusion criteria were enrolled in our study. As part of the RE-COVER trial, we carried out analysis of comprehensive examination and treatment of 55 patients with venous thromboembolism (VTE), who were randomly divided into two groups. Group I (Control Group) consisted of 30 patients receiving initial therapy with heparin for seven days followed by taking warfarin for six months. Group II (Study Group) comprised 25 patients taking dabigatran etexilate instead of warfarin.

Results. There were no cases of recurrent VTE in the Control Group, and one (4%) patient of the Study Group was found to have a relapse of the disease owing to resistance to anticoagulation therapy and congenital thrombophilia. Undesirable events of anticoagulation therapy developed in 20% of the Control Group patients an in 16% of the Study Group patients. In two Control Group patients and one Study Group patient anticoagulation therapy was discontinued due to the development of complications. After 2 years, 36.7% of the Control Group patients and 40% of the Study Group patients had no manifestations of chronic venous insufficiency (CVI). The degree of CVI was similar in the both groups.

Conclusion. Dabigatran proved non-inferior to warfarin regarding efficacy, possessing, however, a series of advantages: it has a predictable anticoagulant effect, requires neither monitoring of the haemostasis system, nor dose adjustment, and is administered at standard dosages.

KEY WORDS: dabigatran, warfarin venous thromboembolism.

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