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Is there a role for low-dose DOACs as prophylaxis?
Alexander T Cohen1, Beverley J Hunt1
1The Thrombosis & Haemophilia Centre, Guy's & St. Thomas' National Health Service, London, United Kingdom.
Hematology. American Society of Hematology. Education Program
|December 7, 2019
Summary
Low-dose direct oral anticoagulants (DOACs) offer a safer alternative for long-term thromboprophylaxis. These medications provide effective prevention of venous thromboembolism (VTE) and arterial events with reduced bleeding risks compared to traditional treatments.
Area of Science:
- Pharmacology
- Cardiology
- Hematology
Background:
- Direct oral anticoagulants (DOACs) have revolutionized thrombotic disorder management.
- Established indications include stroke prevention in atrial fibrillation and venous thromboembolism (VTE) treatment/prevention.
Observation:
- This review focuses on the under-recognized benefits of low-dose DOACs for thromboprophylaxis.
- Low-dose DOACs present a potentially lower bleeding risk than standard doses and significantly less than vitamin K antagonists (VKAs).
Findings:
- Low-dose DOACs enable safer long-term anticoagulation due to an improved risk-benefit profile.
- Detailed discussion covers extended use in secondary VTE prevention.
- Utility is explored in hospital-associated VTE, post-arthroplasty, and cancer patients.
- Role in secondary arterial event prevention is also briefly addressed.
Implications:
- Low-dose DOACs expand therapeutic options for prolonged thromboprophylaxis.
- These agents may improve patient outcomes in various clinical settings by mitigating bleeding complications.
- Further research into optimal dosing and long-term safety in specific patient populations is warranted.
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