Related Experiment Video
Updated: Mar 7, 2026
A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
The Novel Oral Anticoagulants for Acute Venous Thromboembolism: Is Warfarin Dead?
Alexander T Cohen1, Serena Granziera2, Nicola Veronese3
1Department of Haematological Medicine, King's College, London, United Kingdom.
Abstract:
The direct oral anticoagulants (DOACs) have been compared with parenteral anticoagulants and vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE) in several robust studies. DOACs have shown similar efficacy in preventing recurrent VTE and significant reductions in critical site (intracranial) bleeding, fatal bleeding, major and nonmajor bleeding. Warfarin and other VKAs are not dead as treatment modalities for VTE. A better way to describe the current situation is to use a boxing expression, "down but not out." VKAs and parenteral anticoagulants still have a role to play in the management of VTE in several clinical settings. In indications where DOACs can be used, VKAs should not, as the safety profile of VKAs is considerably worse than DOACs. Hence, guidelines are now recommending DOACs in preference to VKAs. In this article, we consider where DOACs are indicated, where there is growing evidence for use, where we have little evidence for use, and finally where there is no evidence for use and where they, thus, should not be used. We have included recommendations and examples of our own practice which may not be applicable to all settings.
Insights
Direct oral anticoagulants (DOACs) offer similar efficacy to warfarin and parenteral anticoagulants for venous thromboembolism (VTE) treatment. DOACs significantly reduce bleeding risks, making them preferred over VKAs where applicable.
Area of Science:
- Pharmacology
- Hematology
- Clinical Medicine
Background:
- Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are used for venous thromboembolism (VTE) treatment.
- Comparative studies have evaluated DOACs against parenteral anticoagulants and VKAs.
Purpose of the Study:
- To compare the efficacy and safety of DOACs versus traditional anticoagulants for VTE.
- To delineate the current and future roles of DOACs and VKAs in VTE management.
- To provide guidance on DOAC indications, evidence levels, and contraindications.
Main Methods:
- Review of robust clinical studies comparing DOACs with parenteral anticoagulants and VKAs.
- Analysis of efficacy in preventing recurrent VTE.
- Assessment of bleeding outcomes, including critical site, fatal, major, and nonmajor bleeding.
Main Results:
- DOACs demonstrate comparable efficacy to traditional anticoagulants in preventing recurrent VTE.
- DOACs show significant reductions in various bleeding events compared to VKAs.
- Guidelines increasingly recommend DOACs over VKAs due to a better safety profile.
Conclusions:
- DOACs are recommended over VKAs in indications where they are suitable.
- VKAs and parenteral anticoagulants retain roles in specific clinical VTE settings.
- Understanding DOAC indications and contraindications is crucial for optimal VTE management.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:30Venous Thrombosis IV: Nursing Management
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Venous Thrombosis I: Introduction