From the Guidelines
Direct Oral Anticoagulants (DOACs) have a similar efficacy to traditional anticoagulants, such as Vitamin K Antagonists (VKAs), in reducing the risk of Venous Thromboembolism (VTE) in patients with chronic venous insufficiency, but with a lower risk of intracranial bleeding.
Key Points
- The use of DOACs instead of VKAs for patients with VTE does not impact mortality, but may reduce the risk of Deep Vein Thrombosis (DVT) 1
- DOACs are associated with a lower risk of clinically relevant bleeding in patients treated for VTE, compared to traditional anticoagulants 1
- The risk reduction for recurrent VTE with all DOACs appears to be similar to the risk reduction with VKAs, although direct comparison between DOACs is limited 1
DOACs and Bleeding Risk
- DOACs may carry a higher risk of gastrointestinal bleeding, particularly dabigatran, edoxaban, and rivaroxaban, compared to VKAs 1
- Apixaban may have a lower risk of bleeding compared to other DOACs 1
Clinical Implications
- The choice of anticoagulant therapy should be individualized, taking into account the patient's risk of thrombosis and bleeding, as well as other clinical factors 1
- DOACs may be a suitable option for patients with chronic venous insufficiency who require anticoagulation therapy, due to their convenience and reduced risk of intracranial bleeding 1
From the Research
Relationship between Direct Oral Anticoagulants (DOAC) and Chronic Venous Insufficiency
- The current evidence does not directly address the relationship between DOACs and chronic venous insufficiency 2, 3, 4, 5, 6.
- However, studies suggest that DOACs are effective in preventing and treating venous thromboembolism (VTE), which can be a complication of chronic venous insufficiency 2, 3, 4, 5, 6.
- One study mentions that DOACs represent one of the therapeutic and preventive options of deep venous thrombosis (DVT) and of venous thromboembolism (VTE) with a limitation in patients with malignant conditions and in pregnancy 3.
- Another study notes that superficial vein thromboses longer than 5 cm are indicated to anticoagulant therapy, which may include DOACs 3.
Use of DOACs in Patients with Venous Thromboembolism
- DOACs have been shown to be effective in preventing recurrent VTE, with a significant reduction in VTE recurrence compared to warfarin 2.
- DOACs also have a favorable safety profile, with lower risks of major bleeding, clinically relevant non-major bleeding, and gastrointestinal bleeding compared to warfarin 2.
- However, the use of DOACs may be limited in certain patient populations, such as those with mechanical heart valves, thrombotic antiphospholipid syndrome, and cancer-associated thrombosis 4, 5.
Considerations for DOAC Use in Special Populations
- Patients with chronic kidney disease (CKD) may require dose adjustment of DOACs, and therapeutic drug monitoring may be considered to guide clinical management 6.
- In patients on maintenance dialysis, the use of DOACs is still being studied, and current evidence questions the need for oral anticoagulation in patients with atrial fibrillation due to high rates of major bleeding 6.