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[Towards 'the best DOAC'?]

Sander van Doorn1, Frans H Rutten1, G J Geersing1,2

  • 1UMC Utrecht, Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde.

Nederlands Tijdschrift Voor Geneeskunde
|April 5, 2019
PubMed
Summary
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Direct oral anticoagulants (DOACs) offer alternatives for stroke prevention in atrial fibrillation and venous thromboembolism treatment. This expert consensus compares DOACs and vitamin K antagonists, based on indirect evidence due to limited head-to-head trials.

Area of Science:

  • Pharmacology and Therapeutics
  • Cardiovascular Medicine
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) are gaining prominence for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) treatment.
  • Traditional anticoagulation therapy involves vitamin K antagonists (VKAs), which have established protocols but require frequent monitoring.

Purpose of the Study:

  • To provide guidance on the differences between various available DOACs.
  • To compare DOACs with traditional vitamin K antagonist treatments.
  • To offer an expert consensus on DOAC selection and use in clinical practice.

Main Methods:

  • The study is a short overview and expert consensus.
  • Comparisons are predominantly based on indirect meta-analyses.

Related Experiment Videos

  • Observational evidence is utilized to infer differences and efficacy.
  • Main Results:

    • The overview highlights potential differences among DOACs, although direct comparative trials are lacking.
    • Indirect evidence suggests varying profiles for different DOACs and comparisons to VKAs.
    • The findings emphasize the need for cautious interpretation due to the reliance on indirect data.

    Conclusions:

    • Expert consensus suggests DOACs are valuable therapeutic options, but careful consideration of individual patient factors is necessary.
    • The current evidence base, primarily from indirect comparisons, necessitates a nuanced approach to DOAC selection.
    • Further head-to-head trials are needed to definitively establish the comparative efficacy and safety of different DOACs.