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Review
. 2017 Jun 23:6:985.
doi: 10.12688/f1000research.11174.1. eCollection 2017.

Recent advances in the treatment of venous thromboembolism in the era of the direct oral anticoagulants

Jeffrey I Weitz  1   2   3 , Iqbal H Jaffer  4   3 , James C Fredenburgh  1   3
Affiliations
Review

Recent advances in the treatment of venous thromboembolism in the era of the direct oral anticoagulants

Jeffrey I Weitz et al. F1000Res. .

Abstract

The direct oral anticoagulants (DOACs) have now supplanted vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE). The DOACs include dabigatran, which inhibits thrombin, and rivaroxaban, apixaban, and edoxaban, which inhibit factor Xa. The DOACs are as effective for the prevention of recurrence as conventional VTE treatment, consisting of a parenteral anticoagulant followed by a VKA, and are associated with less bleeding. Because of these properties and the convenience of fixed dosing without the need for routine coagulation monitoring, guidelines now recommend DOACs over VKAs for VTE treatment in patients without active cancer. This paper examines the increasing role of the DOACs for VTE treatment.

Keywords: DOACs; VTE; anticoagulant; direct oral anticoagulants; venous thromboembolism.

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Conflict of interest statement

Competing interests: Jeffrey Weitz has received research support from Canadian Institutes of Health Research, Heart and Stroke Foundation, Canadian Foundation for Innovation, and Boehringer Ingelheim and consulting fees from Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Bayer, Janssen Pharmaceuticals, Portola, IONIS Pharmaceuticals, and Merck. Iqbal Jaffer has received research support from Boehringer Ingelheim and consulting fees from CryoLife. James Fredenburgh declares that he has no competing interests.Competing interests: Menno V Huisman has previously collaborated with the author, Jeffrey Weitz, on the RE-VERSE AD™ trial (NCT02104947).No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Management of direct oral anticoagulant-associated bleeding.
With minor bleeding, local measures and delaying or holding 1–2 doses is sufficient. With moderate to severe bleeding, the direct oral anticoagulant should be held, and supportive therapy should be administered. For life-threatening bleeding, reversal should be undertaken.
See this image and copyright information in PMC

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