Management of antithrombotic therapy in gray areas of venous thromboembolism: a Delphi consensus panel

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Direct-acting oral anticoagulants (DOACs) are established treatments for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).
• Clinical trials do not fully cover all real-world VTE patient scenarios, leading to uncertainty in DOAC application.
• Expert consensus is needed to guide DOAC use in complex VTE cases.

Purpose of the Study:

• To establish a Delphi Consensus among Italian physicians on the use of DOACs in specific VTE patient populations and clinical situations.
• To address uncertainties regarding DOAC efficacy, safety, and optimal management strategies in VTE.
• To provide evidence-based recommendations for real-world DOAC application in VTE.

Main Methods:

• A Delphi Consensus process involving 46 Italian physicians from various specialties (cardiology, internal medicine, angiology, oncology, hematology, geriatrics).
• Physicians rated agreement on 7 key topics related to DOAC use in VTE using a 5-point Likert scale.
• Consensus was defined as agreement of ≥66% among respondents.

Main Results:

• The consensus addressed DOAC superiority over VKAs, management of intermediate-risk PE, DVT treatment, DOACs in cancer patients, reversal agent use, low-dose DOAC safety, and long-term therapy.
• Detailed results for each of the seven topics were achieved through the Delphi process.
• The consensus provides expert opinion on several debated aspects of DOAC therapy in VTE.

Conclusions:

• The Delphi Consensus offers guidance on the application of DOACs in various real-world VTE scenarios not fully covered by clinical trials.
• Expert agreement was reached on key aspects of DOAC use, including specific patient populations and treatment durations.
• This consensus aims to standardize and optimize DOAC therapy for VTE patients in clinical practice.