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ABSTRACT
Pulmonary embolism (PE) is a leading cause of mortality worldwide. Recognizing PE and administering anticoagulants can significantly improve patient outcomes by reducing mortality rates and preventing recurrent events. For more than 50 years, standard therapy has involved parenteral anticoagulation followed by long-term therapy with the vitamin K antagonist warfarin. However, management of warfarin therapy is challenging due to its narrow therapeutic range and interactions with genetic and environmental factors. Direct oral anticoagulants (DOACs) have been developed to simplify anticoagulation and avoid the concerns associated with warfarin. DOACs are administered at a fixed dosage without routine monitoring and have few drug interactions. In recent years, DOACs have received FDA approval for the treatment of acute deep venous thrombosis (DVT) and PE based on the results of well-conducted clinical trials. This review discusses approaches to the diagnosis and treatment of PE and the use of DOACs as an alternative to warfarin treatment for the management of the disease. While many of the indications for DOACs and concepts discussed apply to both DVT and PE, our focus will be acute PE.
Declaration of interest
Medical writing and editorial support was provided by Sameera Kongara, PhD, of AlphaBioCom, LLC (King of Prussia, PA), and funded by Daiichi Sankyo, Inc. (Parsippany, NJ). VF Tapson discloses conflicts of interest with Inari Medical Incorporated, Bayer Healthcare Pharmaceuticals, Janssen R&D, LLC, EKOS Corp/BTG International Group Company, and Daiichi Sankyo, Inc. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.