The History and Historical Treatments of Deep-Vein Thrombosis: Towards the Era of New Anticoagulants.

Abstract

Deep-vein thrombosis (DVT) is a common disease. In a previous review published in 2013 we provided a comprehensive history of DVT management, with particular emphasis on treatments that were later introduced or abandoned. At that time the history of direct oral anticoagulants (DOACs) was still emerging and we chose not to delve into this topic at that point. Twelve years later, DOACs have become the standard of care for DVT treatment, revolutionizing management by simplifying therapy while also influencing the intensity and duration of anticoagulant treatment. This new historical review focuses on aspects of DVT treatment that were not covered previously, including the quest of the development of safer and more user-friendly alternatives to older anticoagulants, the evolving history of anticoagulant treatment duration and intensity, as well as how studies have influenced the American College of Chest Physicians guidelines. Though great successes have been achieved, this review will highlight that anticoagulation philosopher's stone has yet to be found, if ever found. Nevertheless, recent data on inhibitors of Factor XI/XIa might suggest that we are approaching closer to safer anticoagulants. Looking ahead, in the absence of possibility for a single universal treatment for DVT, the future of DVT treatment will probably lie both on the development of newer anticoagulants but also on the development of artificial intelligence which could offer individualized treatment.