Direct oral anticoagulants for treatment of venous thrombosis: illustrated review of appropriate use

Essentials•Randomized trials suggest that direct oral anticoagulants (DOACs) may not be as safe or effective for mangement of venous thromboembolism (VTE) in certain situations.•We review scenarios where DOACs are safe and effective, where they have reduced safety or efficacy, and when their safety and/or efficacy are uncertain.•DOACs are not advised for VTE in antiphospholipid syndrome or luminal cancers.•The safety and efficacy of DOACs for VTE remain uncertain in some conditions.AbstractDirect oral anticoagulants (DOACs) have become the preferred option for treatment of venous thromboembolism due to their favorable profile compared with other agents such as vitamin K antagonists or low-molecular-weight heparin. However, findings from randomized controlled trials suggest efficacy and/or safety concerns with DOAC use in some clinical contexts. This illustrated review will summarize indications where DOACs have proven efficacy and safety, situations where they fall short, and situations where uncertainty remains compared with other treatments for venous thromboembolism.