When Direct Oral Anticoagulants Should Not Be Standard Treatment: Jacc State-Of-The-Art Review Publisher Pubmed



Bejjani A^{1, 2, 3} ; Khairani CD^{1, 2} ; Assi A⁴ ; Piazza G^{1, 2, 4} ; Sadeghipour P⁶ ; Talasaz AH^{7, 8} ; Fanikos J⁹ ; Connors JM¹⁰ ; Siegal DM¹¹ ; Barnes GD¹² ; Martin KA¹³ ; Angiolillo DJ¹⁴ ; Kleindorfer D¹⁵ ; Monreal M¹⁶ Show All Authors
Source: Journal of the American College of Cardiology Published:2024

Abstract

For most patients, direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prevention in atrial fibrillation and for venous thromboembolism treatment. However, randomized controlled trials suggest that DOACs may not be as efficacious or as safe as the current standard of care in conditions such as mechanical heart valves, thrombotic antiphospholipid syndrome, and atrial fibrillation associated with rheumatic heart disease. DOACs do not provide a net benefit in conditions such as embolic stroke of undetermined source. Their efficacy is uncertain for conditions such as left ventricular thrombus, catheter-associated deep vein thrombosis, cerebral venous sinus thrombosis, and for patients with atrial fibrillation or venous thrombosis who have end-stage renal disease. This paper provides an evidence-based review of randomized controlled trials on DOACs, detailing when they have demonstrated efficacy and safety, when DOACs should not be the standard of care, where their safety and efficacy are uncertain, and areas requiring further research. © 2024 American College of Cardiology Foundation