Mortality Rates Drop Dramatically with Wider Use of Anticoagulants

New Formulations Might Be More Effective

By Annette M. Boyle

Lt. Col. Andrew P. Cap, MD, PhD, FACP

Lt. Col. Andrew P. Cap, MD, PhD, FACP

BETHESDA, MD – In the last 50 years, the use of anticoagulants has transformed mortality rates for deep vein thrombosis (DVT), pulmonary embolism (PE) and atrial fibrillation, and new anticoagulants and recommendations for use may save even more lives in the next few years.

“Improved diagnostics (CT scan) and effective treatments have greatly reduced mortality risk associated with venous thromboembolism,” according to a statement provided to U.S. Medicine by Lt. Col. Andrew P. Cap, MD, PhD, FACP, chief of blood research at the U.S. Army Institute of Surgical Research, associate professor of medicine at the Uniformed Services University and staff hematologist-oncologist at the San Antonio Military Medical Center, and Lt. Col. Todd Villines, MD, cardiology consultant to the Army Surgeon General and professor of medicine at the Uniformed Services University.

The first randomized controlled trial documenting any benefit of anticoagulation was published during the 1960s. In the following two decades, the risk of fatal pulmonary embolism from untreated DVT was about 16%. Today, treatment with anticoagulants has reduced the risk to less than 1%. The risk of death from unrecognized or untreated PE in the 1960s and 1970s has been estimated to be 30% to 65%, compared to current rates of about 2%.1

While anticoagulants were first used in DVT/PE, usage in other conditions has also achieved significant improvements in mortality rates. “The use of anticoagulation for the prevention of stroke and systemic embolism in patients with atrial fibrillation has been shown to dramatically reduce subsequent risk of cardioembolic events by more than 60%,” Villines and Cap said.

For those in the military, warfarin, the first and for years the only anticoagulant, was a double-edged sword. Using it saved lives; needing it ended careers.

Lt. Col. Todd Villines, MD

Lt. Col. Todd Villines, MD

“In a conscript Army, most soldiers with thrombotic disorders or other conditions requiring long-term anticoagulation would have been separated from service,” Cap and Villines said.

The situation is not as black and white today. While the need for long-term anticoagulation will still frequently trigger a medical board to determine fitness for continued service, as anticoagulated patients are generally considered nondeployable, other circumstances might allow a soldier to receive anticoagulants and stay in the service.

“Over the course of the last decade of conflict in Southwest Asia, many active-duty servicemembers have been treated for trauma-related DVT/PE. The duration of anticoagulation for most of these patients is three to six months and this duration of therapy does not trigger a medical board,” Villines and Cap noted.

 

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