For most patients with lower-extremity deep vein thrombosis (DVT), direct oral anticoagulants (DOAs) can replace safely and effectively vitamin K antagonists (VKAs), with multiple benefits. Some DOAs can be started immediately upon diagnosis, without any previous treatment with low-molecular-weight heparin (LMWH). In some settings and patients, initial LMWH therapy should, however, be favored. Though their use should not be trivialized and precautions are necessary, DOAs facilitate the management of the 3-month anticoagulation that is required in most DVT patients. DOAs, at full or reduced dose, are probably most beneficial in patients requiring prolonged or long-term anticoagulation. This article reviews the current management of DVT using DOAs and summarizes the main criteria for identifying candidates to prolonged or long-term anticoagulation.
Key Words
Deep vein thrombosis, anticoagulant therapy, LMWH, VKA, direct oral anticoagulant
What is already known about the topic?
For several decades, the standard anticoagulant therapy for most lower-extremity deep vein thrombosis (DVT) patients has consisted in the administration of low-molecular-weight heparin (LMWH) and vitamin K antagonist (VKA) overlapping for several days until a therapeutic INR is reached, followed by VKA alone under INR monitoring.
Though effective, this treatment is associated with significant constraints and bleeding risks, thus limiting the number of patients eligible for prolonged anticoagulation.
What does this article bring up for us?
Direct oral anticoagulants (DOAs) provide a validated, safe, effective, and convenient alternative to the traditional therapeutic regimen for DVT. They facilitate – with certain precautions – the initiation of anticoagulant therapy, and most importantly can offer a long-term effective, safe, and less burdensome oral anticoagulation to many patients at risk of DVT recurrence.