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Safety ad efficacy of direct oral anticoagulants for extended treatment of venous thromboembolism

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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.

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Correspondence to Davide Imberti.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Imberti, D., Pomero, F., Benedetti, R. et al. Safety ad efficacy of direct oral anticoagulants for extended treatment of venous thromboembolism. Intern Emerg Med 11, 895–900 (2016). https://doi.org/10.1007/s11739-016-1521-8

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  • DOI: https://doi.org/10.1007/s11739-016-1521-8

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