Key result
DOACs show no significant difference in thrombosis or bleeding vs VKAs in jugular vein thrombosis.
Why the study?
Vitamin K antagonists are the guideline-recommended first-line therapy for internal jugular vein thrombosis, whereas data on the use of direct oral anticoagulants in this setting remain limited.
Do direct oral anticoagulants provide comparable efficacy and safety to vitamin K antagonists and parenteral anticoagulants in patients with internal jugular vein thrombosis?
Observational (n=29)
No
Do direct oral anticoagulants provide comparable efficacy and safety to vitamin K antagonists and parenteral anticoagulants in patients with internal jugular vein thrombosis?
Absolute Event Rate: 0% vs 29.4%
p-value: p=0.119
In this small retrospective case series of patients with internal jugular vein thrombosis, direct oral anticoagulants were associated with zero thrombotic recurrences and no major bleeding events, suggesting they may be a safe and effective alternative to vitamin K antagonists.
DOACs may warrant evaluation in internal jugular vein thrombosis; leaves open their comparative efficacy and safety versus vitamin K antagonists in prospective trials.
Internal jugular vein thrombosis (IJVT) is an uncommon form of venous thrombosis that may be associated with either transient or persistent risk factors. According to current international guidelines, vitamin K antagonists (VKAs) represent the first-line anticoagulant therapy; however, data on the use of direct oral anticoagulants (DOACs) in this setting remain limited. The aim of this case series was to describe the clinical characteristics and to compare the efficacy and safety outcomes of VKAs, DOACs, and parenteral anticoagulants in patients with IJVT. In this retrospective single-center study, we consecutively enrolled 29 patients, 17 were treated with VKAs, 10 with DOACs and 2 with parenteral anticoagulants. Among five patients who experienced recurrence of thrombosis, three cases occurred following discontinuation of anticoagulant therapy. The remaining two recurrences were observed during ongoing treatment. Five bleeding events were reported, with no difference among the three groups and none classified as major bleeding. These findings suggest that DOACs may be a safe and effective option for anticoagulant treatment in IJVT, as evidenced by low recurrence rates during therapy and the absence of major bleeding events.
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Pannunzio et al. (2026) conducted an observational in Internal jugular vein thrombosis (IJVT) (n=29). Direct oral anticoagulants (DOACs: apixaban or rivaroxaban) vs. Vitamin K antagonists (n=17, 94.1% warfarin) and parenteral anticoagulants (n=2, low-molecular-weight heparin or fondaparinux) was evaluated on Thrombotic events (recurrence of venous thromboembolism) (p=0.119). Direct oral anticoagulants resulted in 0% thrombotic events and 10.0% bleeding vs 29.4% and 23.5% with vitamin K antagonists in internal jugular vein thrombosis (p=0.119 and p=0.534).
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