Janusz Świeczkowski-Feiz, Aleksandra Maciejczyk, Alicja Bury, Agata Karpińska

Anticoagulant Therapy with Direct-Acting Oral Anticoagulants (DOACs): A Comprehensive Review

2025-02-05

Subject of the research. This research is a systematic review of direct-acting oral anticoagulants (DOAC) that constitute an undisputed anticoagulant therapy, ensuring the highest quality of life for patients. DOACs directly inhibit activated clotting factors. Dabigatran is a direct thrombin inhibitor and rivaroxaban, apixaban and edoxaban are highly selective oral factor Xa inhibitors disrupting both intrinsic and extrinsic pathways of the coagulation cascade.

Aim of the research. Assessing the potential superiority of DOACs over other anticoagulant therapies in diverse clinical scenarios and characterizing the specific advantages, if any, associated with their use. The cases under analysis included oncological patients, patients with mechanical valves, the utilization of anticoagulants in medical interventions and the diverse patient groups. Despite established guidelines, the optimal management of venous thromboembolism in cancer patients remains a challenge.

Materials and methods. A systematic literature search was conducted using PubMed and Google Scholar, employing keywords such as "anticoagulant therapy", "direct-acting oral anticoagulants (DOAC)", "venous thromboembolism", "pulmonary embolism", and "deep vein thrombosis". Fifty-one articles meeting the inclusion criteria were selected, focusing on the efficacy and safety of DOACs in managing venous thromboembolism. Data on treatment outcomes, adverse effects, and clinical applications were synthesized, adhering to PRISMA guidelines to ensure a comprehensive and transparent review.

Results. DOACs offer an attractive alternative in various clinical settings, including post-valve replacement. Studies comparing DOACs with vitamin K antagonists post-TAVI patients demonstrate comparable efficacy and safety profiles, with potential benefits including ease of administration, fewer drug interactions, and improved patient adherence. Managing bleeding complications in patients on anticoagulant therapy remains a clinical challenge. Additionally, elderly patients pose unique challenges due to age-related changes affecting drug metabolism and increased bleeding risk, particularly with certain oral anticoagulants like rivaroxaban. However, further research is warranted to establish long-term safety and efficacy, optimize dosing strategies, and refine management protocols, particularly in high-risk patient populations.

Conclusions. Direct-acting oral anticoagulants have transformed anticoagulant therapy, offering comparable efficacy to vitamin K antagonists with improved safety and convenience. Their targeted mechanisms ensure effective thromboembolism prevention, particularly in oncology and post-valve replacement patients, while enhancing quality of life. However, challenges such as bleeding management and optimal dosing in high-risk populations highlight the need for further research to optimize their use in diverse clinical settings.

Keywords: Anticoagulant therapy, direct-acting oral anticoagulants (DOAC), venous thromboembolism, pulmonary embolism, deep vein thrombosis.

© Farm Pol, 2024, 80(9): 607–619