Q&A on Betrixaban, the First Preventive VTE Treatment

How does the FDA's approval of betrixaban for venous thromboembolism (VTE) impact the way physicians treat their patients?

Karol Watson, MD, professor of medicine and cardiology, co-director of Preventive Cardiology, director of Barbara Streisand UCLA Women's Heart Health Program, UCLA: That's a good question. We've had Xa inhibitors around for prevention of stroke in atrial fibrillation. We've had treatment of VTE. But now we have a medication for prevention of VTE, which is a really important thing.

I'm going to over-share a bit, because my mother had a VTE in the past, and it's one of those things that everytime she gets on a plane, I get nervous. But the fact there could be something now to prophlyaxigance — that's huge, because the downstream effects of VTE morbidity happens most commonly in older patients. They don't always recover, so having something than can prevent that is big.

Will this impact the way phsyicians talk to patients about their condition?

Watson: I think, as a cardiologist, we're used to seeing the downsides, or what happens afterwards, and most of these patients are going to be care for by primary physicians. Certainly anyone at risk, that discussion needs to happen, and certainly anyone who has had a prior VTE, that discussion needs to happen.

If it were my patient and they happen to be in my clinic, I would certainly have that discussion, as I will with my mother.

How crucial are preventive treatments for VTE, compared to standard treatment?

Watson: I'm a preventive cardiologist, I run the program in preventive cardiology. It is so much better to prevent something than to worry about treating it, because there are certain things you can't get back fully functioning. So I think if you have someone at risk, it makes so much sense to think about preventing this.

Is there any hope to limit adverse bleeding-related effects in VTE treatment?

Watson: Every time we deal with anticoagulants, or even anti-platelets, it's always a balancing act between efficacy against thrombosis, and safety against bleeding. So, that's where we have to get really smart about risk assessment and figure out who's at risk most.

What I always tell my patients, my trainees, my fellow colleagues is, "You have to figure out what's likely to kill that patient today." And I agree — every drug has potential side effects you always have to consider. The most important question to say is, what is your major threat to life right now?

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