Emerging treatments
Betrixaban
Betrixaban, a direct factor Xa inhibitor, has been approved by the US Food and Drug Administration for the prophylaxis of venous thromboembolism (VTE) in adults (with restricted mobility and other risk factors for VTE) hospitalised for an acute illness.
Sulodexide (for prevention of recurrent PE)
Evidence suggests that sulodexide, a mixture of fast-moving heparin and dermatan sulfate, may be useful in secondary prevention of PE, but it is not in widespread clinical use currently. It is not commercially available in Europe or the US as yet.[248]
The 2019 European Society of Cardiology guideline for the diagnosis and management of acute PE states that sulodexide may be considered for extended VTE prophylaxis in patients who refuse to take or are unable to tolerate any form of oral anticoagulants, based on level B evidence (a single randomised clinical trial [RCT]).[67]
The recommendation about sulodexide was based on a single RCT involving 615 patients with a first VTE event (but only 8% had a PE) without an identifiable risk factor, who had completed 3 to 12 months of oral anticoagulant treatment, randomised to sulodexide or placebo for 24 months.[248]
Sulodexide reduced the risk of VTE recurrence (hazard ratio [HR] 0.49, 95% CI 0.27 to 0.92; P = 0.02) without significantly increasing clinically relevant bleeding (HR 0.97, 95% CI 0.14 to 6.88; P = 0.98).[248]
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