Abstract
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation
management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention.
Clinical trials and secondary real-world data have shown that DOACs have similar efficacy
and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists.
Together with benefits of patient convenience, this has shifted the risk–benefit ratio
toward long-term anticoagulation. However, current VTE risk assessment models are
based on vitamin K antagonists and do not take into account the new paradigm of DOACs.
Therefore, challenges to the thrombosis community remain to determine patients who
would benefit from long-term anticoagulation in the DOAC era. Here, the authors review
the current literature on risks and benefits of DOACs and their potential role in
long-term VTE thromboprophylaxis as well as in current risk assessment models. The
increasing use of DOACs, led by their convenience of use and generally lower bleeding
rates, calls for a reevaluation of the current models as the benefits of long-term
anticoagulation may begin to outweigh risks and inconvenience associated with their
predecessors.
Keywords
direct oral anticoagulants - venous thromboembolism - thromboprophylaxis - DOAC
