Ann Phlebology.  2024 Dec;22(2):39-43. 10.37923/phle.2024.22.2.39.

Direct Oral Anticoagulants in Fragile Patients with Venous Thromboembolism

• Park H
• Park SJ
• Park JI
• Kim JS
• Kwon JA
• Kim H

• KMID: 2565356
• DOI: http://doi.org/10.37923/phle.2024.22.2.39

Abstract

Venous thromboembolism (VTE), a severe condition comprising deep vein thrombosis and pulmonary embolism, requires prompt treatment. Traditional therapies include heparin, low-molecular-weight heparin, and warfarin. Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban has revolutionized VTE management. Clinical trials show that DOACs are as effective as traditional anticoagulants in preventing recurrent VTE, with similar or lower rates of major bleeding. However, DOAC use is complex in vulnerable populations—those with comorbidities, chronic kidney disease, cancer, and advanced age—due to higher VTE and bleeding risks from polypharmacy and altered pharmacokinetics. Trials have shown promising results for DOACs, but these studies often include few patients from these high-risk groups. Moreover, while DOACs are validated for atrial fibrillation, these findings may not apply directly to patients with VTE due to different dosing. In this study, we aimed to address this gap by reviewing the literature on the efficacy and safety of DOACs in these vulnerable populations.

Keyword

Venous thromboembolism; Direct oral anticoagulants; Fragile patients; Bleeding; Recurrence