NEW ORAL ANTICOAGULANTS (NOACS) ARE THE GOLD STANDARD IN VENOUS THROMBOEMBOLISM

Authors

  • Luís F. Antunes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar e Universitário de Coimbra Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

DOI:

https://doi.org/10.48729/pjctvs.73

Abstract

Introduction: Venous Thromboembolism (VTE) is an important cause of morbidity and mortality. The risk of recurrence could be very high without thromboprophylaxis. New oral anticoagulants (NOACs or DOACs) represent a new step in anticoagulation.

Material and Methods: We searched for papers with trials, systematic reviews and meta-analysis involving NOACs in the treatment and secondary prevention of VTE. We also searched for guidelines of two medical societies (American College of Chest Physicians and International Society of Thrombosis and Haemostasis - ISTH).

Results: Six RCT (randomized controlled trial) comparing NOACs with Warfarin shew a non-inferiority in relation with recurrent VTE and major bleeding. Two RCT (SELECT-D and Hokusay cancer) and one meta-analysis shew low recurrence rate of VTE in cancer patients and higher rate of bleeding, mainly in gastrointestinal and genitourinary cancers. There are two RCTs involving NOACs in treatment of patients with Antiphospholipid Syndrome (APS).

Discussion: NOACs shew non-inferiority over AVK. Guidelines of CHEST 2016 recommend NOACs for VTE treatment in no cancer patients, and Low Molecular Weight Heparin (LMWH) for cancer patients. ISTH suggest NOACs as the first option in VTE cancer patients with low risk of bleeding. A recent RCT shews no benefit and increased risk of vascular events in APS patients treated with NOACs. NOACs are the gold standard for VTE treatment and secondary prevention in no cancer patients. They could be the first option in cancer patients with low risk of bleeding.

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References

Cushman M. Treating Acute Venous Thromboembolism: Shift with care. N Engl J Med. 2013; 369:865-866

Fanikos J, Piazza G, Zayaruzny M, Goldhaber SZ. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost. 2009; 102(4):688-93

Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ 3rd. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000; 160(6): 761-8

Prins MH, Lensing AW, Brighton TA, Lyons RM, Rehm J, Trajanovic M, et al. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014; 1(1): e37-46

Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Büller HR. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol. 2000; 18(17): 3078-83

Garcia D, Libby E, Crowther MA. The new oral anticoagulants. Blood. 2010; 115(1): 15-20

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2): 315-352

Helen E Jo, David J Barnes. Role of novel oral anticoagulants in the management and prevention of venous thromboembolism. World J Haematol. 2015; 4(1): 1-9

Schulman S, Kearon C, Kakkar AK, Schellong S, Eriksson H, Baanstra D, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013; 368(8): 709-18

Weitz JI, Lensing AWA, Prins MH, Bauersachs R, Beyer-Westendorf J, Bounameaux H, et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2017; 376(13): 1211-1222

Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol. 2018; 36(20): 2017-2023

Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. 2018; 378(7): 615-624

Li A, Garcia DA, Lyman GH, Carrier M. Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis. Thromb Res. 2019; 173:158-163

Hannah Cohen, Beverley J Hunt, Maria Efthymiou, Deepa R J Arachchillage, Ian J Mackie, Simon Clawson, et al. Lancet Haematol. 2016; 3(9):e426-e436

Pengo V, Denas G, Zoppellaro G, Jose SP, Hoxha A, Ruffatti A, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018; 132(13): 1365-1371

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996; 312(7023):71-2

Khorana AA, Noble S, Lee AYY, Soff G, Meyer G, O'Connell C, et al. J Thromb Haemost. 2018; 16(9): 1891-1894

Robert D McBane, Waldemar E Wysokinski, Jennifer Le-Rademacher, Aneel A Ashrani, Alfonso J Tafur, Krishna Gundabolu, et al. Apixaban, dalteparin, in Active Cancer Associated Venous Thromboembolism, the ADAM VTE Trial. Oral presentation at: American Society of Hematology 60th Annual Meeting & Exposition; December 1-4, 2018; San Diego, California.

Alok A Khorana, Gerald A Soff, Ajay K Kakkar, Saroj Vadhan-Raj, Hanno Riess, Ted Wun, et al. Rivaroxaban thromboprophylaxis in high-risk ambulatory cancer patients receiving systemic therapy: results of a randomized clinical trial (CASSINI). Oral presentation at: American Society of Hematology 60th Annual Meeting & Exposition; December 1-4, 2018; San Diego, California

Dawwas GK, Brown J, Dietrich E, Park H. Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis. Lancet Haematol. 2019; 6(1): e20-e28

Dufrost V, Risse J, Zuily S, Wahl D. Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature. Curr Rheumatol Rep. 2016; 18(12) 74

Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(6): 1308-1313

Agnelli G, Becattini C, Bauersachs R, Brenner B, Campanini M, Cohen A, et al. Apixaban versus Dalteparin for the Treatment of Acute Venous Thromboembolism in Patients with Cancer: The Caravaggio Study. Thromb Haemost. 2018; 118(9): 1668-1678

Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, et al. Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. 2019; 380(8):711-719

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Published

25-04-2021

How to Cite

1.
Antunes LF. NEW ORAL ANTICOAGULANTS (NOACS) ARE THE GOLD STANDARD IN VENOUS THROMBOEMBOLISM. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 25 [cited 2024 May 21];27(1):33-7. Available from: https://pjctvs.com/index.php/journal/article/view/73

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Original Articles