Direct oral anticoagulants (DOACs) are a common treatment for patients with various cardiovascular diseases. DOACs are a preferred treatment over vitamin K antagonists (VKAs) for many patients with atrial fibrillation or venous thromboembolism. This is because the latter has a higher risk of intracranial hemorrhage and the administration procedure is more complex. However, new research suggests that DOACs should not be the first-line treatment for all patients who need blood clot treatment or prevention.

A systematic overview by researchers at Brigham and Women’s Hospital, a founding member of Mass General Brigham, describes the effectiveness of DOACs compared to other treatments. This review utilized data from randomized controlled trials to compare DOACs with other treatments for various cardiovascular diseases. Although there are benefits to using DOACs in many common conditions, this paper shows that DOACs are not recommended for patients with mechanical heart valves, thrombotic antiphospholipid syndrome, atrial fibrillation associated with rheumatic heart disease, and embolic stroke. provides a powerful summary of clinical trials showing worse outcomes. Source unknown. The authors also focus on clinical scenarios where there is uncertainty, looking to the future to generate better evidence.

The results reviewed here have important implications for optimizing anticoagulant therapy and improving patient outcomes in clinical practice. Further research is critically needed into why DOACs may be less effective or safer than standard treatments in certain scenarios. ”

Behnood Bikdeli, MD, MS, Brigham Heart and Vascular Center;