Title
Use of DOACs in the Secondary Prevention of Venous Thromboembolism in Patients with Severe Thrombophilia
Authoring Organization
Publication Month/Year
September 2, 2024
Last Updated Month/Year
October 1, 2024
Supplemental Implementation Tools
Document Type
Consensus
Country of Publication
Global
Document Objectives
Direct Oral Anticoagulants (DOACs) are the first line anticoagulants for the secondary prevention of venous thromboembolism (VTE). However, patients with severe inherited thrombophilias represent a group where the efficiency and safety of DOACs is poorly studied. In this communication, we focus on the utility of DOACs in the secondary prevention of VTE in patients with severe thrombophilia. Current evidence is based only on cohort or single center studies, and poor data is available on compliance of the patients in the studies. Analysis of the studies suggested that full-dose DOACs and vitamin K antagonists (VKAs) have a similar efficacy and bleeding risk in the secondary prevention of VTE in patients with thrombophilia; with a low hazard ratio for recurrent VTE calculated from cohort studies for DOAC vs warfarin, ranging from 0.3 to 0.75. We wish to highlight that treatment failure is greater in those with severe forms of Protein S deficiency (below 20%), and possibly in AT deficiency Type II HBS homozygous Budapest 3. In summary, the current approach to using DOACs in patients with severe thrombophilia is dependent on clinical judgment and experience. Limited evidence suggests that for those with severe thrombophilias, full dose DOACs have similar utility as VKAs. We recommend caution in using low - dose DOACs due to lack of evidence. Ideally large randomized multicenter studies are required to develop a reliable treatment algorithm.
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Hospital, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D019851 - Thrombophilia
Keywords
VTE, Venous Thromboembolism, thrombophilia, direct oral anticoagulants, DOAC
Source Citation
Kovac M, Ignjatovic V, Orlando C, Bereczky Z, Hunt BJ. The use of DOACs in the secondary prevention of venous thromboembolism in patients with severe thrombophilia: communication from the ISTH SSC Subcommittee on Physiological Anticoagulants and Thrombophilia. J Thromb Haemost. 2024 Sep 2:S1538-7836(24)00492-6. doi: 10.1016/j.jtha.2024.08.006. Epub ahead of print. PMID: 39233011.