Direct oral anticoagulants are likely as effective and safe as conventional anticoagulants in the treatment of pulmonary embolism
Cochrane Pre-hospital and Emergency Care
Direct oral anticoagulants are likely as effective and safe as conventional anticoagulants in the treatment of pulmonary embolism
SOURCE
Li M, Li J, Wang X, Hui X, Wang Q, Xie S, Yan P, Tian J, 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 pulmonary embolism.
Cochrane Database of Syst Rev 4, CD010957.
CONTEXT
Historically, conventional anticoagulants (heparin, fondaparinux, vitamin K antagonists) have been the standard treatment for pulmonary embolism. Their major drawbacks include the need for regular biological monitoring, as well as potential drug interactions and severe adverse effects. Direct oral anticoagulants (DOACs), including thrombin inhibitors and factor Xa inhibitors, offer the main advantages of being administered orally and not requiring dose adjustments.
CLINICAL QUESTIONS
Are direct oral anticoagulants (DOACs) as effective and safe as conventional anticoagulants in the management of pulmonary embolism?
BOTTOM LINE
The administration of thrombin inhibitors, compared to conventional anticoagulants, is likely to result in little to no difference in terms of recurrence of venous thromboembolism, pulmonary embolism, deep vein thrombosis, and major bleeding (moderate level of evidence).
The administration of factor Xa inhibitors, compared to conventional anticoagulants, is likely to result in little to no difference in terms of recurrence of venous thromboembolism, pulmonary embolism, deep vein thrombosis, and mortality (moderate level of evidence). Additionally, it may result in little to no difference in the occurrence of major bleeding (low level of evidence).
CAVEATS
Future studies should individualize the analysis of each molecule and focus on identifying the effects of DOACs on subgroups of at-risk patients (such as cancer patients, obese individuals, thrombophilic patients). Additionally, it would be valuable to assess the quality of life in these patient populations.
AUTHORS
Nicolas Cazes
nicolas.cazes@icloud.com
Hôpital d’Instruction des armées Laveran
Service des urgences
13013 Marseille, France
Aurélien Renard
Aurelien.renard@smurbmpm.fr
Bataillon de marins-pompiers de Marseille
Groupement santé
F-13233 Marseille, France
