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Review
. 2021 May 26:17:471-487.
doi: 10.2147/TCRM.S271439. eCollection 2021.

Current Opinion on the use of Direct Oral Anticoagulants for the Prophylaxis of Venous Thromboembolism among Medical Inpatients

Jane J Lee  1 , Sahar Memar Montazerin  2 , Fahimehalsadat Shojaei  2 , Gerald Chi  2
Affiliations
Review

Current Opinion on the use of Direct Oral Anticoagulants for the Prophylaxis of Venous Thromboembolism among Medical Inpatients

Jane J Lee et al. Ther Clin Risk Manag. .

Abstract

Venous thromboembolism (VTE) is a known cause of morbidity and mortality, especially among acutely ill medical patients. Although VTE prophylaxis is part of post-discharge clinical care in surgical patients, there is controversy regarding its use in acutely ill medical patients and the current guideline statements suggest against its routine use. Recent clinical trials (APEX, MAGELLAN and MARINER) compared the safety and efficacy of direct oral anticoagulants (including betrixaban and rivaroxaban) with the standard of the care, enoxaparin, to identify the risk-benefit tradeoff. In this review, we summarized the key findings from these trials and substudies and recent updates in society guidelines regarding VTE prevention. In addition, we discussed the potential barriers, cost-effectiveness, and COVID-19 with respect to the implementation of extended-duration or post-discharge usage of direct oral anticoagulants.

Keywords: betrixaban; enoxaparin; major bleeding; medically ill; rivaroxaban; thromboembolic events.

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Conflict of interest statement

The authors reported no conflicts of interest for this work.

Figures

Figure 1
Figure 1
Comparison of incidence of VTE-related events between DOAC and control across different studies.
Figure 2
Figure 2
Subgroup analysis: Comparison of incidence of VTE between DOAC and control.
Figure 3
Figure 3
Subgroup analysis: Comparison of incidence of major bleeding between DOAC and control.
See this image and copyright information in PMC

References

    1. Gibson CM, Spyropoulos AC, Cohen AT, et al. The IMPROVEDD VTE risk score: incorporation of D-Dimer into the IMPROVE score to improve venous thromboembolism risk stratification. TH Open. 2017;1(1):e56. doi:10.1055/s-0037-1603929 - DOI - PMC - PubMed
    1. Heit JA, Crusan DJ, Ashrani AA, Petterson TM, Bailey KR. Effect of a near-universal hospitalization-based prophylaxis regimen on annual number of venous thromboembolism events in the US. Blood. 2017;130(2):109–114. - PMC - PubMed
    1. Cohen AT, Spiro TE, Büller HR, et al. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol. J Thromb Thrombolysis. 2011;31(4):407–416. doi:10.1007/s11239-011-0549-x - DOI - PMC - PubMed
    1. Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368:513–523. doi:10.1056/NEJMoa1111096 - DOI - PubMed
    1. Cohen AT, Harrington R, Goldhaber SZ, et al. The design and rationale for the acute medically ill venous thromboembolism prevention with extended duration betrixaban (APEX) study. Am Heart J. 2014;167(3):335–341. doi:10.1016/j.ahj.2013.11.006 - DOI - PubMed