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  • Indications
  • Treatment of DVT

Acenocoumarol in Treatment of DVT

The use of acenocoumarol in the treatment of symptomatic deep vein thrombosis (DVT) is well-established. Acenocoumarol was shown to be superior to warfarin in efficacy and was effective in cases of warfarin resistance.51,52

Recommendations for oral anticoagulant (OAC) therapy in deep vein thrombosis (DVT) are as follows53:
  1. For patients with a first episode of DVT secondary to a reversible risk factor, long-term treatment with vitamin K antagonists (VKAs) for 3 months is recommended (Grade 1A)
  2. For patients with a first episode of idiopathic DVT, treatment with VKAs for at least 6 to 12 months is recommended (Grade 1A).
  3. For patients with DVT and cancer, low-molecular weight heparin is recommended for the first 3 to 6 months of long-term anticoagulant therapy (Grade 1A). For these patients, anticoagulation is recommended indefinitely or until the cancer is resolved.
  4. For patients with a first episode of DVT and documented antiphospholipid syndrome or who have two or more thrombophilic risk factors (e.g. combined factor V Leiden and prothrombin 20210 gene mutations), treatment for 12 months is recommended (Grade 1C). Indefinite anticoagulant therapy is also recommended in these patients.
  5. For patients with a first episode of DVT who have documented deficiency of antithrombin, protein C or protein S, or the factor V Leiden or prothrombin 20210 gene mutation, homocysteinemia, or high factor VIII levels (>90th percentile), treatment for 6 to 12 months is recommended (Grade 1A). Indefinite therapy is recommended, as for patients with idiopathic thrombosis (Grade 2C).
  6. For patients with two or more episodes of objectively documented DVT, indefinite treatment is suggested (Grade 2A).
  7. It is recommended that the VKA dose be adjusted to maintain a target international normalized ratio (INR) of 2.5 (2.0–3.0) for all treatment durations (Grade 1A). The guidelines recommend against high-intensity VKA therapy (3.1–4.0) (Grade 1A) and against low-intensity therapy (INR range, 1.5–1.9) compared to INR range of 2.0 to 3.0 (Grade 1A).
  8. In patients who receive indefinite anticoagulant treatment, the risk‐benefit of continuing such treatment should be reassessed at periodic intervals (Grade 1C).
  9. Repeat testing with Doppler ultrasound is suggested to exclude residual thrombosis or measurement of plasma D-dimers, to help determine the duration of the treatment (Grade 2C).