Why the study?
Venous thromboembolism prophylaxis after discharge is controversial in acutely ill medical patients, with current guidelines advising against routine use despite recent clinical trials evaluating direct oral anticoagulants.
Does extended-duration or post-discharge use of direct oral anticoagulants improve VTE prophylaxis compared to enoxaparin in acutely ill medical patients?
Does extended-duration or post-discharge use of direct oral anticoagulants improve VTE prophylaxis compared to enoxaparin in acutely ill medical patients?
This review summarizes recent trial data and guidelines on the controversial use of extended-duration DOACs for VTE prophylaxis in acutely ill medical patients.
Extended DOAC prophylaxis should not yet change practice in medical inpatients; leaves open optimal patient selection from trial data.
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.
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Lee et al. (2021) studied this question.
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