A new State-of-the-Art Review in the Journal of American College of Cardiology provides updated evidence from randomized controlled trials (RCTs) on the efficacy and safety of direct oral anticoagulants (DOACs) compared to standard treatments.1 DOACs, including oral factor Xa and thrombin inhibitors, are preferred for stroke prevention in atrial fibrillation and venous thromboembolism (VTE) treatment due to advantages such as fixed dosing and reduced intracranial bleeding risk, compared to vitamin K antagonists.

As detailed in the review’s Central Illustration, certain scenarios have potential limitations, such as mechanical heart valves and thrombotic antiphospholipid syndrome, where DOACs may not be as effective or safe. Uncertainties persist in some conditions, such as cerebral venous sinus thrombosis, and among specific patient subgroups, such as those with end-stage renal disease, cirrhosis, or pregnancy.

The review underscores the need for further research to elucidate DOACs' efficacy, safety, and underlying mechanisms.


1Bejjani A, Khairani CD, Assi A, et al. When direct oral anticoagulants should not be standard treatment: JACC state-of-the-art review. J Am Coll Cardiol. 2024;83(3):444-465. doi:10.1016/j.jacc.2023.10.038.

This summary was created with assistance from generative artificial intelligence (ChatGPT, 2024).

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