Podcast 789: DOAC

<p><strong>Contributor: Aaron Lessen, MD </strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found that Eliquis® had superior outcomes. </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Further data is required to determine the preferred DOAC. A randomized trial comparing the two DOACs is upcoming with enrollment ending in 2023. </span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data.</span> <em><span style="font-weight: 400;">Ann Intern Med</span></em><span style="font-weight: 400;">. 2022;175(1):20-28. doi:10.7326/M21-0717</span></p> <p><span style="font-weight: 400;">Aryal MR, Gosain R, Donato A, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world.</span> <em><span style="font-weight: 400;">Blood Adv.</span></em> <span style= "font-weight: 400;">2019;3(15):2381-2387. doi:10.1182/bloodadvances.2019000572</span></p> <p><span style="font-weight: 400;">Image from:</span></p> <p>Bristol-Myers Squibb Company. Eliquis