Rivaroxaban and other non-vitamin K antagonist oral anticoagulants in the emergency treatment of thromboembolism

Table 1 Current guidelines for the initial treatment of acute PE [3, 7]

Diagnosis	Recommendation	Grade of recommendation/level of evidence
High-risk PE (with hypotension and/or cardiogenic shock)	Thrombolytic therapy (for patients who do not have a high risk of bleeding)	2C (ACCP)/1A (ESC)
High-risk PE (with hypotension and/or cardiogenic shock)	Accompanied by immediate i.v. UFH	1A (ESC)
Non-high-risk PE, including suspected PE	Initial parenteral anticoagulation or rivaroxaban*LMWH or fondaparinux preferred over:	1B (ACCP)/1A (ESC)
	i.v. UFH	2B/C (ACCP)/1A (ESC)
	s.c. UFH	2B/C (ACCP)/1A (ESC)
	For patients at high risk of bleeding and those with severe renal dysfunction, UFH with an aPTT target range of 1.5-2.5 times the normal range	1C (ESC)
	Initial treatment with UFH, LMWH or fondaparinux should continue for at least 5 days, with concurrent VKA started as soon as possible	1B (ACCP)/1A (ESC)
	Parenteral treatment to be discontinued after achieving target INR levels for at least 2 consecutive days	1B (ACCP)/1C (ESC)

*ACCP guidelines only; no grade of recommendation or level of evidence specified. ACCP American College of Chest Physicians, aPTT activated partial thromboplastin time, ESC European Society of Cardiology, INR international normalised ratio, i.v. intravenous, LMWH low molecular weight heparin, PE pulmonary embolism, s.c. subcutaneous, UFH unfractionated heparin, VKA vitamin K antagonist.

ISSN: 1865-1380