What do you mean by "novel"? Factor Xa inhibitors? If so, I use rivaroxaban routinely for DVT, PE.

The newer oral anticoagulants are overused in treatment of VTE and in the prevention of stroke in atrial fibrillation

In our hospital, we started to use dabigatran widely to prevent stroke in patients with non-valvular atrial fibrillation (AF). However, other newer oral anticoagulants (factor Xa inhibitors as rivaroxiban) are not used routinely for treatment of VTE in our hospital as it is expensive.

I would like to draw your attention to the fact that the question tackles the "treatment of VTE" and not the prophylaxis. In acute cases the approach may be different depending on the severity of the case. As far as the anticoagulants are concerned, I do not think the oral factor Xa inhibitors have a place in the first line of treatment of VTE because they are difficult to control. We start with fractionated heparin per perfusion in high doses under hemostasis monitoring or in some cases - HMH in therapeutic doses. After the VTE is placed under control, then oral anticoagulants may be considered for a supportive long-term application.

I use first low molecular weight heparin sc in therapeutic doses and after 15 days introduce acenocumarol. When it reaches appropiate control (INR) then I stop heparin

Dear Dr. Fuster, I agree with this therapeutic approach but not entirely. I presume that the question also involves severe cases of pulmonary embolism (PE). In similar cases the treatment should be more aggressive than just subcutaneous LWH. In extremely severe (fulminant PE) cases fibrinolysis should be considered.

Hello

I am using Rivaroxaban for DVT treatment. That is the only NOA i am using. I am waiting for Apixaban.

The only problem is when patients have no money for it. In this situation I am forced to use the classical treatment but only with LMWH. Do not use warfarin.

Best

Rivaroxaban has taken a significant place in treatment and secondary profilaxis of pts with VTE. 

Dear Rivaroxaban fans, I can not imagine how patients with severe VTE, and especiially those with severe PE accompanied by hemodynamic failure and pulmonary hypertension would be treated with oral anticoagulants. Those patients need IC, intravenous (easily controlable) anticoagulants  or fibrinolysis. In elective cases with massive PE there are indications for pulmonary embolectomy in the conditions of cardio-pulmonary bypass.