Key result
Transitioning between DOACs and other anticoagulants lacks evidence-based guidance, relying mainly on trial protocols.
Why the study?
Transitioning to or from direct oral anticoagulants is common, but circumstances requiring a change in strategy lack evidence-based guidance.
There is a significant lack of evidence-based guidance for transitioning patients between DOACs and other anticoagulants, relying mostly on trial protocols and product information.
INTRODUCTION: The transition to or from direct oral anticoagulants (DOACs) is common in clinical practice. AREAS COVERED: A literature search was conducted on PubMed, Google Scholar, and UpToDate up to March 2024 for conditions and approaches for transitioning from one agent to the other. No randomized clinical trials were retrieved except for two studies regarding switching to DOAC in well-conducted vitamin K antagonist (VKA) therapy. A narrative review was conducted addressing the conditions for switching from one agent to the other, such as thromboembolic events and major bleeding during anticoagulation, development or worsening of kidney or liver failure, initiation of interfering drugs, adverse events such as allergic reactions, frailty, patients' preferences, and affordability. During transitions from one anticoagulant to the other, the risk of both thromboembolic and bleeding complications should be minimized. The current approaches for such transitions are derived from those employed in clinical trials evaluating DOAC and from product information. EXPERT OPINION: Many uncertainties remain regarding those circumstances requiring a change in anticoagulant strategies, as they lack evidence-based guidance. It can be envisaged that the problem of switching to and from DOAC will need additional studies especially addressing the conditions and the best approach to such transitions.
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Cosmi et al. (2024) conducted a review in Anticoagulation therapy. Transitioning between therapeutic anticoagulants (DOACs and VKAs) was evaluated. Transitioning between direct oral anticoagulants and other agents lacks evidence-based guidance, with current approaches derived mainly from clinical trial protocols and product information.
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