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Is there a role for low-dose DOACs as prophylaxis?

Abstract

The direct oral anticoagulants (DOACs) have transformed the management of thrombotic disorders. Large clinical trials have demonstrated that DOACs can replace vitamin K antagonists (VKAs) in the 2 existing major indications for anticoagulation: the prevention of stroke in atrial fibrillation and the acute treatment and secondary prevention of venous thromboembolism (VTE); this literature is widely known. In this article, we will concentrate on the less well-discussed benefits of the use of DOACs-using low doses as primary and secondary prophylaxis in both venous and arterial thromboprophylaxis. The attractiveness of using a low-dose DOAC is that the bleeding risk seems to be slightly lower than with the standard dose and significantly lower than with VKAs so that they can be used safely for long periods, where previously, VKAs had risk/benefit ratios that did not permit this. We discuss in detail the extended use of low-dose DOACs in secondary VTE prevention. We also cover the utility of low-dose DOACs in the evolving fields of prevention of hospital-associated VTE in acutely ill medical patients, after total hip and knee replacement, and in cancer patients. To complete the indications, we briefly discuss the role of low-dose DOACs in the secondary prevention of arterial vascular events.

Authors+Show Affiliations

The Thrombosis & Haemophilia Centre, Guy's & St. Thomas' National Health Service, London, United Kingdom.The Thrombosis & Haemophilia Centre, Guy's & St. Thomas' National Health Service, London, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31808883

Citation

Cohen, Alexander T., and Beverley J. Hunt. "Is There a Role for Low-dose DOACs as Prophylaxis?" Hematology. American Society of Hematology. Education Program, vol. 2019, no. 1, 2019, pp. 187-193.
Cohen AT, Hunt BJ. Is there a role for low-dose DOACs as prophylaxis? Hematology Am Soc Hematol Educ Program. 2019;2019(1):187-193.
Cohen, A. T., & Hunt, B. J. (2019). Is there a role for low-dose DOACs as prophylaxis? Hematology. American Society of Hematology. Education Program, 2019(1), pp. 187-193. doi:10.1182/hematology.2019000026.
Cohen AT, Hunt BJ. Is There a Role for Low-dose DOACs as Prophylaxis. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):187-193. PubMed PMID: 31808883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is there a role for low-dose DOACs as prophylaxis? AU - Cohen,Alexander T, AU - Hunt,Beverley J, PY - 2020/12/06/pmc-release PY - 2019/12/7/entrez PY - 2019/12/7/pubmed PY - 2019/12/7/medline SP - 187 EP - 193 JF - Hematology. American Society of Hematology. Education Program JO - Hematology Am Soc Hematol Educ Program VL - 2019 IS - 1 N2 - The direct oral anticoagulants (DOACs) have transformed the management of thrombotic disorders. Large clinical trials have demonstrated that DOACs can replace vitamin K antagonists (VKAs) in the 2 existing major indications for anticoagulation: the prevention of stroke in atrial fibrillation and the acute treatment and secondary prevention of venous thromboembolism (VTE); this literature is widely known. In this article, we will concentrate on the less well-discussed benefits of the use of DOACs-using low doses as primary and secondary prophylaxis in both venous and arterial thromboprophylaxis. The attractiveness of using a low-dose DOAC is that the bleeding risk seems to be slightly lower than with the standard dose and significantly lower than with VKAs so that they can be used safely for long periods, where previously, VKAs had risk/benefit ratios that did not permit this. We discuss in detail the extended use of low-dose DOACs in secondary VTE prevention. We also cover the utility of low-dose DOACs in the evolving fields of prevention of hospital-associated VTE in acutely ill medical patients, after total hip and knee replacement, and in cancer patients. To complete the indications, we briefly discuss the role of low-dose DOACs in the secondary prevention of arterial vascular events. SN - 1520-4383 UR - https://www.unboundmedicine.com/medline/citation/31808883/Is_there_a_role_for_low-dose_DOACs_as_prophylaxis L2 - https://ashpublications.org/hematology/article-lookup/doi/10.1182/hematology.2019000026 DB - PRIME DP - Unbound Medicine ER -