title: Safety ad efficacy of direct oral anticoagulants for extended treatment of venous thromboembolism.
abstract: Currently available anticoagulants have limitations for long-term treatment of venous thromboembolism (VTE). We have evaluated the efficacy and safety of direct oral anticoagulants (DOACs) for extended treatment of VTE. Four randomized controlled trials (RCTs) comparing DOACs (apixaban, rivaroxaban, and dabigatran) with placebo or warfarin for extended treatment of VTE were published. Primary efficacy outcome was recurrent VTE or VTE-related death, and primary safety outcome was major bleeding. DOACs significantly lower the risk of recurrent VTE or VTE-related death compared to placebo/warfarin, as well as all-cause mortality. Risk of major bleeding is not different with DOACs compared to placebo/warfarin. However, DOACs are associated with a significantly higher rate of the composite of major and clinically relevant bleeding compared to placebo. In conclusion, DOACs are effective and safe for the extended treatment of VTE, and may reduce the risk of all-cause mortality.
authors.affiliation: Haemostasis and Thrombosis Center, Internal Medicine Department, Piacenza Hospital, Via Taverna 49, Piacenza, Italy. d.imberti@ausl.pc.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Imberti
authors.affiliation: Internal Medicine Department, Hospital 'Santa Croce e Carle', Cuneo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Pomero
authors.affiliation: Haemostasis and Thrombosis Center, Internal Medicine Department, Piacenza Hospital, Via Taverna 49, Piacenza, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Benedetti
authors.affiliation: Internal Medicine Department, Hospital 'Santa Croce e Carle', Cuneo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fenoglio
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000069604:Dabigatran / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D011720:Pyrazoles / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000503:physiopathology; D014812:Vitamin K / Q000494:pharmacology / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; D001241:Aspirin
keywords: Deep vein thrombosis; Direct oral anticoagulants; Extended treatment; Pulmonary embolism; Venous thromboembolism