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Journal of Thrombosis and Thrombolysis
Published in: Journal of Thrombosis and Thrombolysis 3/2019

01-10-2019 | Dabigatran

Safety of direct oral anticoagulants versus traditional anticoagulants in venous thromboembolism

Authors: Michela Giustozzi, Laura Franco, Maria Cristina Vedovati, Cecilia Becattini, Giancarlo Agnelli

Published in: Journal of Thrombosis and Thrombolysis | Issue 3/2019

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Abstract

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide. For decades, low molecular weight heparins (LMWH) and vitamin K-antagonists have been the gold standard of anticoagulation for VTE. Recently, direct oral anticoagulants (DOACs) that can be administered in fixed doses, without laboratory monitoring and dose adjustment have revolutionized anticoagulation management in VTE. Here, we report on recent evidence regarding the safety of DOACs compared to traditional anticoagulants in surgical and medical prophylaxis as well as in acute and extended treatments of VTE. Additionally, we provide data on special situations such as elderly, cancer and renal impairment patients. Regarding antithrombotic prophylaxis, data are lacking on DOAC use in general surgical patients, while DOACs appear to be more effective than and as safe as LMWHs in VTE prophylaxis for major orthopedic surgical patients. Whether a medically ill patient may benefit from extended VTE prophylaxis remains unclear. In fact, in these patients, DOACs showed an increased risk of bleeding compared to conventional therapy. In the acute treatment of VTE, DOACs were non-inferior and probably safer than conventional anticoagulation therapy while in the extended VTE treatment DOACs were more effective than placebo or aspirin with a comparable risk of major bleeding. These favorable results were also confirmed in elderly, cancer and renal impairment patients. However, further investigations are needed in order to generalize the safe use of DOACs in these specific subgroups of patients.
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Metadata
Title
Safety of direct oral anticoagulants versus traditional anticoagulants in venous thromboembolism
Authors
Michela Giustozzi
Laura Franco
Maria Cristina Vedovati
Cecilia Becattini
Giancarlo Agnelli
Publication date
01-10-2019
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 3/2019
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-019-01878-x

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