![]() ![]() 4,8-14 Furthermore, a recent systematic review and meta-analysis of 13 randomized control trials evaluated mortality data and showed that DOACs were associated with lower rates of fatal bleeding, cardiovascular mortality, and all-cause mortality compared with warfarin. In addition, DOACs had a lower risk of bleeding and similar risk of major fatal bleeding compared with warfarin. 4-7 Several other large phase 3 clinical trials have shown that DOACs were noninferior to warfarin regarding acute VTE treatment and prevention of recurrent VTE. Since 2009, four large multicenter, randomized, double-blind, placebo-controlled trials demonstrated that DOACs were noninferior in the prevention of stroke in patients with nonvalvular atrial fibrillation and had a lower risk of bleeding compared with warfarin. ![]() This expert consensus was largely driven by multiple recent, large clinical trials that have established the efficacy and safety of DOACs for stroke prevention and VTE treatment and prevention. ![]() 2 However, according to the most recent CHEST guidelines on antithrombotic therapy for venous thromboembolism (VTE), experts in the field of anticoagulation agreed that DOACs provide advances in efficacy, overall safety, and patient and provider simplicity as the preferred anticoagulant when compared with warfarin in patients without cancer. 1 Until recently, warfarin has been the standard therapy for oral anticoagulation. There are two different types of oral anticoagulation, including vitamin-K antagonists (VKAs), such as warfarin, and the new class of direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and endoxaban. ![]() Oral anticoagulation is a clinical therapeutic that is frequently prescribed by numerous providers in many medical settings. ![]()
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