When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review (JACC January 2024-2)-Article: When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review

Article: When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review

Pdf Summary

The summary provides an overview of the effectiveness and safety of direct oral anticoagulants (DOACs) in various medical conditions. The efficacy and safety of DOACs are generally established, but there are specific scenarios and patient populations where their effectiveness and safety are uncertain due to limited evidence.<br /><br />In conditions such as mechanical heart valves, rheumatic atrial fibrillation, and thrombotic antiphospholipid syndrome, DOACs may be less effective or safe compared to vitamin K antagonists (VKAs). They may also not provide a net benefit in conditions such as embolic stroke of undetermined source. The efficacy of DOACs in conditions such as left ventricular thrombus, catheter-associated deep vein thrombosis, cerebral venous sinus thrombosis, and end-stage renal disease is uncertain. <br /><br />The review highlights the need for further research in these areas to establish the efficacy and safety of DOACs. The summary also mentions ongoing trials that are investigating the effects of DOACs in these conditions.<br /><br />Additionally, the use of DOACs during pregnancy is uncertain due to limited data showing potential risks to the fetus. The summary emphasizes the need for more research in this area as well.<br /><br />Overall, while DOACs are generally preferred in most patients, the decision on whether to use them should be based on individual patient characteristics and the available evidence. Further research, including larger randomized controlled trials, is necessary to determine the optimal use of DOACs in specific scenarios and patient populations.

Keywords

DOACs

efficacy

safety

medical conditions

embolic stroke

left ventricular thrombus

deep vein thrombosis

cerebral venous sinus thrombosis

end-stage renal disease

pregnancy