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Thromb Haemost
DOI: 10.1055/a-2451-4014
Invited Clinical Focus

Direct Oral Anticoagulants: Quick Primer on When to Use and When to Avoid

Antoine Bejjani
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
2   Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
3   Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Behnood Bikdeli
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
2   Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
4   Yale New Haven Hospital/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
5   Cardiovascular Research Foundation, New York, New York, United States
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Abstract

Direct oral anticoagulants (DOACs) have transformed the landscape of antithrombotic therapy in the past two decades. However, there is uncertainty about when they should or should not be used for treatment or prevention of thromboembolic events. DOACs have largely replaced warfarin for many patients with atrial fibrillation or venous thromboembolism who require anticoagulant therapy. In addition to noninferior efficacy, fewer drug–drug and food–drug interactions and improved convenience; DOACs have been shown to reduce the risk of intracranial hemorrhage. They have also received new indications compared with warfarin, such as cardiovascular risk reduction in patients with stable atherosclerotic diseases. However, there are some scenarios in which DOACs are associated with inferior efficacy or worse safety compared with standard treatment, such as warfarin. These include patients with mechanical heart valves, thrombotic antiphospholipid syndrome, and others. Although DOACs offer a streamlined and convenient option for the management of many patients with or at risk of thromboembolic events, their use should be avoided in certain high-risk scenarios. This minireview summarizes such conditions and those in which there is uncertainty for use of DOACs for particular diseases or particular patient subgroups.

Keywords

direct oral anticoagulant - anticoagulant - warfarin - thromboembolism - thrombosis


Publication History

Received: 14 September 2024

Accepted: 24 October 2024

Article published online:
18 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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