CHEST Guidelines-Time-to-Use-Direct-Oral-Anticoagulants-to-Prevent-

Time-to-Use-Direct-Oral-Anticoagulants-to-Prevent-

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The editorial from the journal CHEST discusses the use of direct oral anticoagulants (DOACs) to prevent the recurrence of venous thromboembolism (VTE) and major acute cardiovascular events (MACE) after initial VTE episodes. Traditionally, venous and arterial thromboses were seen as separate conditions, requiring anticoagulants and antiplatelets, respectively. However, recent evidence suggests a link between these conditions and overlaps in risk factors, such as obesity and hypertension. Studies indicated that unprovoked VTE is associated with endothelial dysfunction and increased cardiovascular events risk. Aspirin and rosuvastatin have shown efficacy in reducing VTE recurrences and incidence.<br /><br />The editorial references a study by Noumegni et al., which examined a large cohort of VTE patients in France. The study found a reduced risk of MACE in patients treated with anticoagulants, particularly when treated for longer durations. This supports previous findings that vitamin K antagonists (VKAs) reduce recurrent cardiovascular events but come with increased bleeding risks. The editorial also notes that despite these drawbacks, there is potential in using DOACs for extended secondary prevention of VTE and MACE.<br /><br />In the current DOAC era, notable reductions in MACE with DOACs compared to VKAs were observed. Still, the study urges further research into the efficacy and optimal dosing of DOACs for secondary prevention of VTE. It highlights the need to define study outcomes for future research, potentially combining venous and arterial event considerations.<br /><br />Overall, the editorial posits that the use of DOACs for preventing recurrent VTE could also mitigate major cardiovascular events, encouraging further studies to refine treatment protocols and possibly change current prevention approaches to VTE and MACE.

Keywords

direct oral anticoagulants

venous thromboembolism

major acute cardiovascular events

endothelial dysfunction

anticoagulants

vitamin K antagonists

secondary prevention

obesity

hypertension

aspirin