Deep vein thrombosis

[Blind date18]

why don't we use direct factor 10a or 2a inhibitors as first line prophylaxis for DVT instead we use warfarin is there any specific reason for this????

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[rjosh33]

What's your source on this? From medscape (emphasis mine): "First-line therapy for non-high risk venous thromboembolism or pulmonary embolism consists of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) over vitamin K antagonists."

As to why warfarin might still be chosen over a NOAC, NOACs have no reversal agent and are much more expensive. Also, warfarin has a longer half-life and could be preferred for non-compliant patients that occasionally miss doses. And, of course, some docs are just comfortable with what they know -- warfarin does have a long-established track record of success.

 

[OrgoCoop]

DVT prophylaxis is with heparin or enoxaparin. Warfarin is commonly used for afib.

 

[sahell]

What's your source on this? From medscape (emphasis mine): "First-line therapy for non-high risk venous thromboembolism or pulmonary embolism consists of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) over vitamin K antagonists."

As to why warfarin might still be chosen over a NOAC, NOACs have no reversal agent and are much more expensive. Also, warfarin has a longer half-life and could be preferred for non-compliant patients that occasionally miss doses. And, of course, some docs are just comfortable with what they know -- warfarin does have a long-established track record of success.

NOACs can be used. Dabigatran can be reversed with idaricuzumab and the others with aflibercept (Not sure - saw it in an Rx question). Warfarin needs hep bridge and monitoring unlike NOACs. These probably haven't made it onto the test yet, but no guarantees. They shouldn't give you both options unless they sneak a contraindication into the stem.