Thromb Haemost 2017; 117(07): 1317-1325
DOI: 10.1160/TH17-01-0065
Review Article
Schattauer GmbH

NOACs for treatment of venous thromboembolism in clinical practice

Sam Schulman
1  Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
,
Daniel Singer
2  Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
,
Walter Ageno
3  University of Insubria, Varese, Italy
,
Ivan B. Casella
4  University of Sao Paulo, Sao Paulo, Brazil
,
Marc Desch
5  Boehringer Ingelheim, Germany
,
Samuel Z. Goldhaber
6  Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
› Author Affiliations
Further Information

Publication History

Received: 30 January 2017

Accepted after major revision: 05 April 2017

Publication Date:
28 November 2017 (online)

Summary

Randomised controlled trials have provided important information on the efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) for treatment of venous thromboembolism (VTE), leading to registration and increasing use in clinical practice. Many questions remain to be answered, and observational studies are often more suitable for answering “real-world” questions than randomised controlled trials. Patient satisfaction, quality of life, and adherence and persistence in clinical practice with the drug regimen can only be assessed with an open-label design. Evaluation of risk for long-term sequelae of the disease requires much longer follow-up than is possible in registration trials. Treatment patterns and utilisation of health care resources can be assessed from observations in the clinical practice setting. We will review published as well as currently active observational studies with NOACs in VTE, with or without a comparator anticoagulant. These studies are based on cohorts of different sizes, registries, or administrative health care databases. We will also discuss some limitations in analysis and interpretation of observational studies.