Key result
Direct oral anticoagulants demonstrate comparable or superior efficacy to warfarin in preventing stroke and systemic embolism, with a significantly lower risk of intracranial hemorrhage.
Why the study?
Do direct oral anticoagulants (DOACs) improve efficacy and safety compared to vitamin K antagonists and LMWH in patients with or at risk for thromboembolic events?
Do direct oral anticoagulants (DOACs) improve efficacy and safety compared to vitamin K antagonists and LMWH in patients with or at risk for thromboembolic events?
DOACs offer a favorable risk/benefit ratio compared to traditional anticoagulants, particularly by significantly reducing intracranial hemorrhage, and are now preferred for most patients with NVAF and VTE.
Supports DOAC preference to minimize ICH; leaves open net benefit confirmation in prospective trials.
Thromboembolic events are the leading cause of morbidity and mortality worldwide. From the second half of the 20th century, vitamin K antagonists (VKAs), warfarin and acenocoumarol, were the only anticoagulants taken orally. The major reform in anticoagulation therapy was made by the advent of direct oral anticoagulants (DOACs), about 10 years ago. Direct thrombin inhibitor (dabigatran) and direct inhibitors of factor Xa (rivaroxaban, apixaban, edoxaban, and betrixaban) have demonstrated favorable risk/benefit ratio. Compared to warfarin, DOACs are associated with a predictable pharmacokinetic profile, lower severe bleeding complications, particularly intracranial hemorrhages, and minimal drug interactions. Moreover, DOACs achieve a rapid onset of action and have shown comparable efficacy with warfarin and low molecular weight heparin (LMWH) in clinical trials. As a result, DOACs are now replacing VKAs and LMWH for many indications including stroke and systemic embolism prevention in nonvalvular atrial fibrillation, prevention, and treatment of venous thromboembolism and thromboprophylaxis following total knee/hip replacement surgery. In addition, rivaroxaban (in combination with aspirin alone or aspirin and clopidogrel) is used in the prevention of atherothrombotic events following acute coronary syndrome with elevated cardiac biomarkers. In case of severe bleeding complications under DOACs treatment, antidotes are available; idarucizumab for dabigatran reversal and andexanet alfa for rivaroxaban and apixaban.
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Stepanović‐Petrović et al. (2020) conducted a review in Thromboembolic events (NVAF, VTE). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) and Low molecular weight heparin (LMWH) was evaluated. Direct oral anticoagulants demonstrate comparable or superior efficacy to warfarin in preventing stroke and systemic embolism, with a significantly lower risk of intracranial hemorrhage.
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