Deep vein thrombosis: fewer major bleeding events with similar efficacy of direct oral anticoagulants compared to conventional anticoagulants

Cochrane Pre-hospital and Emergency Care

Deep vein thrombosis: fewer major bleeding events with similar efficacy of direct oral anticoagulants compared to conventional anticoagulants

SOURCE

Wang X, Ma Y, Hui X, Li M, Li J, Tian J, Wang Q, Yan P, Li J, Xie P, Yang K, Yao L. (2023)
Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis.
Cochrane Database Syst Rev,4: CD010956.

CONTEXT

Historically, deep vein thrombosis (DVT) has been treated with heparin, fondaparinux, or vitamin K antagonists. The major drawbacks of these treatments include the need for regular biological monitoring, drug interactions, and serious adverse effects. Direct oral anticoagulants (DOACs), including thrombin inhibitors and factor Xa inhibitors, have replaced these traditional treatments and are now widely used.

CLINICAL QUESTIONS
Are DOACs as effective and safe as conventional anticoagulants in the management of DVT? Does the use of DOACs influence the risk of post-thrombotic syndrome (chronic sequelae of DVT) and quality of life?

BOTTOM LINE
Regardless of the anticoagulant treatment chosen, there is likely no statistically significant difference in the occurrence of DVT recurrence, thromboembolism, pulmonary embolism, or all-cause mortality (moderate level of evidence). However, DOACs significantly reduce the risk of major bleeding (high level of evidence).
Post-thrombotic syndrome has been evaluated in a single study. The use of rivaroxaban compared to warfarin reduces its incidence. As for quality of life, assessed in a single study, the use of dabigatran compared to warfarin appears to improve it, but in a non-significant manner.

CAVEATS

Due to the significant interindividual variability in the anticoagulant effect of DOACs, further research is needed to study the adjustment of dosing for different subgroups (elderly individuals, cancer patients, those with severe trauma, and thrombophilic abnormalities). Moreover, it is important to compare DOACs with one another, as their effects vary, and to investigate the impact of extended anticoagulant therapy and the discontinuation of DOACs. Post-thrombotic syndrome and quality of life are also crucial outcomes to be studied.

AUTHORS
Nicolas Cazes
nicolas.cazes@icloud.com
Hôpital d’Instruction des armées Laveran, F-13013, Marseille, France

Yannick Auffret
y.aunmail@gmail.com
Urgence SMUR, F-29200 Brest, France