Semin Thromb Hemost 2018; 44(03): 261-266
DOI: 10.1055/s-0038-1637750
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Direct Oral Anticoagulants and the Paradigm Shift in the Management of Venous Thromboembolism

Hui Yin Lim
1  Department of Haematology, Northern Health, Epping, Victoria, Australia
2  Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
3  The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
,
Harshal Nandurkar
2  Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
,
Prahlad Ho
1  Department of Haematology, Northern Health, Epping, Victoria, Australia
2  Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
3  The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
20 March 2018 (online)

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.