When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review.
Review published in Journal of the American College of Cardiology (2024)
Abstract
For most patients, direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prevention in atrial fibrillation and for venous thromboembolism treatment. However, randomized controlled trials suggest that DOACs may not be as efficacious or as safe as the current standard of care in conditions such as mechanical heart valves, thrombotic antiphospholipid syndrome, and atrial fibrillation associated with rheumatic heart disease. DOACs do not provide a net benefit in conditions such as embolic stroke of undetermined source. Their efficacy is uncertain for conditions such as left ventricular thrombus, catheter-associated deep vein thrombosis, cerebral venous sinus thrombosis, and for patients with atrial fibrillation or venous thrombosis who have end-stage renal disease. This paper provides an evidence-based review of randomized controlled trials on DOACs, detailing when they have demonstrated efficacy and safety, when DOACs should not be the standard of care, where their safety and efficacy are uncertain, and areas requiring further research.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
For most patients, direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prevention in atrial fibrillation and for venous thromboembolism treatment. However, randomized controlled trials suggest that DOACs may not be as efficacious or as safe as the current standard...
Por qué esto importa para la hirudoterapia
Esta revisión examina la evidencia de ensayos controlados aleatorizados para identificar escenarios clínicos donde los anticoagulantes orales directos pueden no ser eficaces o seguros, incluidas las válvulas cardíacas mecánicas, el síndrome antifosfolípido trombótico y la fibrilación auricular asociada a cardiopatía reumática. También destaca las condiciones donde la eficacia de los DOAC es incierta, como el trombo del ventrículo izquierdo, la trombosis venosa profunda asociada a catéter y la trombosis de senos venosos cerebrales. El resumen no contiene ninguna mención de sanguijuelas, hirudoterapia, anticoagulantes derivados de sanguijuela, ni enfoques anticoagulantes alternativos o localizados. No existe una conexión defendible con el ámbito de ASH, ya que el foco se centra exclusivamente en la evaluación de agentes farmacéuticos orales y sus limitaciones clínicas.
Citación
When Direct Oral Anticoagulants Should Not Be Standard Treatment: JACC State-of-the-Art Review.
Bejjani et al. · Journal of the American College of Cardiology, 2024
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026