Related Experiment Video

Updated: Feb 27, 2026

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
06:45

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Published on: February 10, 2023

16.6K

Is it reasonable to use a lower DOAC dose in some patients with VTE? NO

Francesco Dentali1, Chiara Fantoni2

  • 1Department of Clinical Medicine, University of Insubria - Ospedale di Circolo, Via Guicciardini 9, 21100, Varese, Italy. fdentali@libero.it.

Internal and Emergency Medicine
|June 29, 2017
PubMed

Insights

Direct oral anticoagulants (DOACs) are recommended for venous thromboembolism (VTE) and atrial fibrillation (AF). Lower DOAC doses are not advised for VTE patients, as studies show increased recurrence risk without reduced bleeding.

Area of Science:

  • Pharmacology
  • Cardiology
  • Thrombosis

Background:

  • International guidelines favor direct oral anticoagulants (DOACs) over vitamin K antagonists for long-term anticoagulation in venous thromboembolism (VTE) and non-valvular atrial fibrillation (AF).
  • DOAC dosing guidelines recommend dose reductions for AF patients with renal impairment, low body weight, or interacting medications.
  • Unlike AF patients, dose reductions for VTE patients are generally not recommended, except for Edoxaban, based on similar criteria.

Purpose of the Study:

  • To discuss the appropriateness of lower DOAC doses in specific patient populations with VTE.
  • To evaluate the evidence regarding dose adjustments for DOACs in VTE treatment compared to AF treatment.

Main Methods:

  • Review of observational studies and randomized controlled trials (RCTs) comparing DOAC use in AF and VTE patients.
  • Analysis of real-world data on DOAC dosing and outcomes in VTE patients.

Main Results:

  • Patients with AF often present with comorbidities and polypharmacy, increasing bleeding risk, unlike typical VTE patients.
  • VTE patients treated with inappropriately low DOAC doses showed higher VTE recurrence rates.
  • The bleeding risk was comparable between VTE patients on correct and incorrect DOAC doses.

Conclusions:

  • Lowering DOAC doses in VTE patients, based on criteria used for AF, is not supported by current evidence.
  • The use of lower DOAC doses in VTE patients may be unreasonable and potentially increase the risk of adverse events like recurrence.

Keywords:
AnticoagulationDirect oral anticoagulantDose reductionVenous thromboembolism

More Related Videos

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis10:26

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Published on: June 2, 2015

18.0K
Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane08:05

Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane

Published on: December 9, 2022

5.1K

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
423
Dosage Regimen: Fixed Dose01:01

Dosage Regimen: Fixed Dose

Fixed-dose regimens are a common approach to administer drugs to achieve and maintain desired levels of the drug in the body. In this dosing strategy, a specific amount of medication is given at regular intervals, often multiple times a day, to ensure a consistent drug concentration in the bloodstream.
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
2.5K
Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
315
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
2.1K
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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...
2.6K
Dosage Regimen: Multiple Oral Dosage01:25

Dosage Regimen: Multiple Oral Dosage

Understanding how a drug's concentration fluctuates within the body over time is crucial in pharmacokinetics, particularly with multiple oral doses. A graphical representation of multiple oral dosages provides insight into these dynamics. Typical accumulation curves of a drug's concentration in the body reveal a sawtooth pattern, indicating periodic peaks and troughs correlating with each dose administration and the drug's subsequent elimination.The plasma concentration at any time during an...
303