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Direct Oral Anticoagulants in Select Patients With Hypercoagulable Disorders
Sara M Valanejad1, Kyle A Davis2
1University of Virginia Health, Charlottesville, VA, USA.
The Annals of Pharmacotherapy
|October 26, 2020
Summary
Direct oral anticoagulants (DOACs) show promise for cancer-associated thrombosis, but their use in antiphospholipid syndrome and hereditary thrombophilia requires caution due to safety concerns.
Area of Science:
- Hematology
- Pharmacology
- Clinical Medicine
Background:
- Venous thromboembolism (VTE) poses risks, especially in patients with hypercoagulable disorders.
- Direct oral anticoagulants (DOACs) offer an alternative to traditional anticoagulants.
- The efficacy and safety of DOACs in specific hypercoagulable states are not fully established.
Purpose of the Study:
- To review the literature on DOAC safety and efficacy for VTE treatment and prevention.
- To assess DOAC use in patients with cancer-associated thrombosis (CAT), antiphospholipid syndrome (APS), and hereditary thrombophilias.
Main Methods:
- Conducted a PubMed literature search from January 2010 to July 2020.
- Keywords included DOACs, specific drug names, and various thrombophilic conditions.
- Included articles reporting clinical outcomes for CAT, APS, and hereditary thrombophilias.
Main Results:
- DOACs (edoxaban, rivaroxaban, apixaban) are supported for CAT treatment; apixaban shows lower bleeding risk.
- Rivaroxaban use in APS is linked to poorer outcomes.
- Limited data exists for DOACs in hereditary thrombophilia, primarily in low-risk individuals.
Conclusions:
- Select DOACs are effective for treating CAT.
- Current evidence suggests avoiding DOACs in APS and hereditary thrombophilia.
- Further research is needed to clarify DOAC use in specific hypercoagulable disorders.
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