When Direct Oral Anticoagulants Should Not Be Standard Treatment
SCENARIOS IN WHICH DOACs HAVE DEMONSTRABLE EFFICACY AND SAFETY
- stroke prevention in atrial fibrillation (SPAF)
- atrial fibrillation and acute coronary syndromes or recent percutaneous coronary intervention(the ideal regimen for stable patients who have undergone percutaneous intervention or had a recent acute coronary syndrome and have atrial fibrillation is a DOAC with a single antiplatelet agent, preferably a P2Y12 inhibitor, for which clopidogrel is typically chosen)
- In patients with atrial fibrillation with many types of valvular heart disease, DOACs are currently recommended
- For patients with VTE, guidelines recommend the use of DOACs for acute management,including for cancer-associated thrombosis, as well as extendedduration secondary prevention of VTE
- In patients with stable atherosclerotic cardiovascular disease or after recent peripheral artery revascularization, low-intensity rivaroxaban was shown to play a role in the reduction of cardiovascular events in combination with aspirin.
SCENARIOS WHERE DOACs ARE LESS EFFICACIOUS OR SAFE, OR PROVIDE NO BENEFIT COMPARED WITH STANDARD OF CARE
- Mechanical heart valves
- Rheumatic atrial fibrillation
- THROMBOTIC ANTIPHOSPHOLIPID SYNDROME
- TRANSCATHETER AORTIC VALVE REPLACEMENT.
- EMBOLIC STROKE OF UNDETERMINED SOURCE
- LEFT VENTRICULAR ASSIST DEVICE
- HEART FAILURE WITH REDUCED LEFT VENTRICULAR SYSTOLIC FUNCTION WITHOUT AF
SCENARIOS WHERE THE SAFETY/EFFICACY OF DOACs IS UNCERTAIN
- Catheter-associated deep vein thrombosis
- Splanchnic vein thrombosis
- UNCERTAIN INDICATIONS. Left ventricular thrombus
- Cerebral venous sinus thrombosis
- SUBGROUPS WITH UNCERTAIN EVIDENCE. End-stage renal disease
- BREASTFEEDING AND PREGNANCY
- Adult congenital heart disease
- Chronic thromboembolic pulmonary hypertension
