Direct oral anticoagulants for unusual‐site venous thromboembolism

• Published in: Research and practice in thrombosis and haemostasis Vol. 5; no. 2; pp. 265 - 277
• Main Authors: Riva, Nicoletta, Ageno, Walter
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021; Elsevier Limited; John Wiley and Sons Inc; Elsevier
• Subjects: Abdomen; Anticoagulants; Ascites; Budd‐Chiari syndrome; Cancer; Contraindications; cranial sinus thrombosis; direct‐acting oral anticoagulants; Liver cirrhosis; Mortality; Ovaries; portal vein; Pulmonary arteries; Risk factors; State of the Art Isth 2020; Thromboembolism; Thrombosis; Tumors; upper extremity deep vein thrombosis; Veins & arteries; venous thromboembolism; portal vein; cranial sinus thrombosis; Budd‐Chiari syndrome; upper extremity deep vein thrombosis; venous thromboembolism; direct‐acting oral anticoagulants
• ISSN: 2475-0379; 2475-0379
• DOI: 10.1002/rth2.12480

Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half‐life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual‐site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual‐site VTE.