Clinical Question

Are direct oral anticoagulants better than conventional anticoagulants (e.g., warfarin) for the treatment of venous thromboembolism (VTE)?

Evidence-Based Answer

Direct oral anticoagulants are as effective as conventional anticoagulants at preventing recurrent deep venous thrombosis (DVT) or pulmonary embolism (PE) and reducing all-cause mortality. Direct oral anticoagulants slightly decrease the likelihood of major bleeding compared with conventional anticoagulants in the treatment of VTE (number needed to treat [NNT] = 123 for direct thrombin inhibitors; NNT = 156 for oral factor Xa inhibitors).^1,2 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

VTE is when a blood clot forms in a vein. The most common types are PE and DVT. An estimated 300,000 to 600,000 cases of PE occur annually in the United States.³ Due to the life-threatening nature of VTE, effective anticoagulation is essential for treatment and mortality reduction. Conventional therapy uses unfractionated heparin, low-molecular-weight heparin, fondaparinux, and vitamin K antagonists. More recently developed anticoagulants include two forms of direct oral anticoagulants: thrombin inhibitors and Xa inhibitors. Direct oral anticoagulants have several preferable characteristics compared with conventional therapy, including a more predictable effect, less frequent monitoring or redosing, and fewer drug interactions.⁴ The authors of these Cochrane reviews sought to assess the safety and effectiveness of direct oral anticoagulants vs. conventional therapies.