Response to Comment on: “Carbon footprint of direct oral anticoagulants in atrial fibrillation and venous thromboembolism”

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Atrial fibrillation and venous thromboembolism. Intervention: Direct oral anticoagulants (DOACs). Primary outcome: Carbon footprint of direct oral anticoagulants.

Nicolas Gendron; Victorien Monguillon

doi:10.3324/haematol.2026.302310

November 12, 2026HaematologicaOpen Access

Response to Comment on: “Carbon footprint of direct oral anticoagulants in atrial fibrillation and venous thromboembolism”

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Key Points

To respond to commentary regarding the life cycle assessment methodology used to quantify the carbon footprint of direct oral anticoagulants in atrial fibrillation and venous thromboembolism.
Author response and methodological discussion evaluating life cycle assessment boundaries, corporate emission allocations, and clinical care pathways in sustainable anticoagulation.
Comparison of emission estimates between the Ecovamed and MCF Classifier databases using a functional unit of one treatment course per patient.
Corporate activities, including research, development, sales, marketing, and regulatory affairs, accounted for 70% of the total carbon footprint of apixaban and rivaroxaban in the Ecovamed model.
Reduced-dose direct oral anticoagulant regimens were associated with carbon footprint reductions of 3.9% to 6.4% at 10 years, while red blood cell transfusions contributed an estimated 7.56 kg CO2-equivalent per unit.
Apixaban dosed twice daily yielded similar emission findings to rivaroxaban dosed once daily because active pharmaceutical ingredient manufacturing dominated the drug footprint rather than administration frequency.

Structured PICO

P

Population

Patients receiving direct oral anticoagulants (DOACs) for atrial fibrillation or venous thromboembolism (VTE)

E

Exposure

Direct oral anticoagulants (DOACs, including apixaban and rivaroxaban) and reduced-dose DOAC regimens after an initial 6 months of full-dose anticoagulation

C

Comparator

Full-dose DOACs or alternative anticoagulation pathways

O

Outcome

Carbon footprint (CO2-equivalent emissions) over the anticoagulation lifecycle

Limitations

Methodological heterogeneity between estimation tools (Ecovamed and MCF Classifier) when boundaries are not harmonized
Potential underestimation of the carbon footprint reduction from reduced-dose DOACs because downstream reductions in bleeding events and associated care were not fully quantified
Methodological heterogeneity between estimation tools (Ecovamed and MCF Classifier) yielding divergent results unless boundaries are harmonized
Carbon footprint reduction from reduced-dose DOACs (3.9% to 6.4%) is possibly underestimated since reduced dosing may also prevent bleeding events and associated care

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Implication

This response highlights that evaluating and reducing the carbon footprint of direct oral anticoagulants requires standardized life cycle assessment boundaries, accounting for corporate emissions, and eliminating low-value clinical practices alongside potential dose-reduction strategies.

Abstract

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Cite This Study

Gendron et al. (2026) conducted a letter in Atrial fibrillation and venous thromboembolism. Direct oral anticoagulants (DOACs) was evaluated on Carbon footprint of direct oral anticoagulants.

synapsesocial.com/papers/6af73b9e9badce7b6084dbcf https://doi.org/10.3324/haematol.2026.302310

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Response to Comment on: “Carbon footprint of direct oral anticoagulants in atrial fibrillation and venous thromboembolism”

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Response to Comment on: “Carbon footprint of direct oral anticoagulants in atrial fibrillation and venous thromboembolism”

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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