In Accordance With Guidelines?
Is therapy of deep vein thrombosis of the upper extremity with non–vitamin K oral anticoagulants (NOACs) covered by approval or by guidelines? The licensing studies have only included patients with deep vein thrombosis of the lower limb. However, the prescribing information for Apixaban and Xarelto state broadly “for the treatment of deep vein thrombosis”. The guidelines refer even more generally to “vein thrombosis”, and each has a section on upper-extremity thrombosis, jugular vein thrombosis, and catheter-associated thrombosis. However, they do not specifically address the use of NAOCs in these types of thrombosis. For me, both the prescribing information and the guidelines appear to deem the use of NOACs as appropriate for all of these manifestations. Not mentioned in the guidelines are, for example, mesenteric vein thrombosis and hepatic vein thrombosis (Budd–Chiari syndrome). However, these are also deep vein thromboses. Is their treatment with NOACs also covered by the approval of NOACs, which indicates they are “for treatment of deep vein thrombosis”?
Prof. Dr. med. Knut Kröger
Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld GmbH, Germany
Conflict of interest statement
Prof. Kröger has received reimbursement for conference fees and travel expenses, as well as honoraria for preparation of scientific meetings, from UCB, Sanofi, GAK, Bayer, BMS, and Aspen.
|1.||Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A: Deep vein thrombosis of the upper extremity—a systematic review. Dtsch Arztebl Int 2017; 114: 244–9 VOLLTEXT|