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Extended-Duration Use of Direct Oral Anticoagulants to Prevent VTE in Acutely III Medical Patients

Jessica W Skelley, Angela R Thomason, Lauren N Hammond

    The Senior Care Pharmacist
    |March 2, 2019
    PubMed

    Insights

    Direct oral anticoagulants (DOACs) reduce venous thromboembolism (VTE) events in acutely ill medical patients. However, extended use increases bleeding risk, necessitating individualized treatment approaches for older adults.

    Area of Science:

    • Pharmacology
    • Clinical Medicine
    • Evidence-Based Practice

    Background:

    • Acutely ill medical patients are at high risk for venous thromboembolism (VTE).
    • Extended-duration thromboprophylaxis is considered for VTE prevention in this population.
    • Direct oral anticoagulants (DOACs) are increasingly used for anticoagulation.

    Purpose of the Study:

    • To evaluate clinical evidence on DOACs for extended thromboprophylaxis in acutely ill medical patients.
    • To assess the efficacy and safety of DOACs regarding VTE and bleeding events.

    Main Methods:

    • Systematic literature search of MEDLINE/PubMed (2008-2018) for relevant clinical trials.
    • Inclusion criteria: acutely ill medical patients, extended VTE prevention, DOACs.
    • Analysis of three clinical trials and two subgroup analyses.

    Main Results:

    • DOACs demonstrated efficacy in preventing VTE events compared to enoxaparin in composite endpoints.
    • Rivaroxaban and apixaban trials showed increased major bleeding events versus enoxaparin.
    • The betrixaban trial reported no significant difference in bleeding compared to enoxaparin.

    Conclusions:

    • DOACs effectively reduce VTE events with extended-duration thromboprophylaxis in acutely ill medical patients.
    • An increased overall bleeding risk is associated with extended DOAC use.
    • Individualized risk assessment is crucial for extended DOAC therapy in older adults post-hospitalization.

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