Steps toward simplifying the treatment of pulmonary embolism

Marco P Donadini, Nicoletta Riva, Alessandro Squizzatoand Walter Ageno

Therapeutic strategies for most patients with pulmonary embolism (PE) include the administration of low-molecular-weight heparin, fondaparinux or unfractionated heparin, followed by vitamin K antagonists. Over the last few years, research has focused on the development of new oral anticoagulant drugs that could overcome some of the main limitations of available parenteral anticoagulants or vitamin K antagonists. These drugs (e.g., dabigatran, rivaroxaban, apixaban or edoxaban) have been compared with standard treatment in a number of Phase III clinical trials in different clinical settings, including the treatment of acute deep-vein thrombosis and PE. The results of the completed trials with dabigatran and rivaroxaban suggest that both compounds can at least be as effective and safe as the standard treatment in these patients. Thus, there is now the possibility of greatly simplifying the treatment of PE patients with drugs that are administered orally and do not require laboratory monitoring. This treatment could be particularly interesting for those PE patients who are deemed eligible for home treatment, based on well-validated scores. However, well-organized outpatient programs need to be implemented before this strategy becomes widely applied.