A study by the RIETE Group analyses how these drugs work in pregnancy, cancer or cirrhosis, among other conditions

Clinical trials of drugs exclude certain patients. Patients at risk of bleeding tend to be excluded, but these people still seek care and doctors often must find other ways to treat them.

Analysing the ideal treatment for patients with diverse situations of daily life was the purpose a study addressed in one of the most recent scientific articles published by the RIETE Group, which was recently presented at the annual congress of the International Society on Thrombosis and Haemostasis (ISTH).

Researchers linked to the RIETE Registry have observed how direct-acting oral anticoagulants (DOACs), or new oral anticoagulants, function in pregnant women, in people with disseminated cancer, liver cirrhosis, severe kidney failure, or low platelet count, and in patients with recent history of serious haemorrhage.

Between 2013 and 2016, 19% of the patients in the RIETE Registry (3578 people) had some of these conditions, which would have excluded them from a clinical trial.

The study analysed the treatment of patients with these profiles with rivaroxaban, one of the four DOACs. It concluded that the behaviour of the drug among the excluded patients is very similar to that of people without extra complications.

In fact, patients with exclusion criteria for a clinical trial who were treated with rivaroxaban at the beginning of treatment bled less than those treated with heparins. In cases in which use of the medication had to be extended, patients also had fewer VTE recurrences and fewer haemorrhages than those who received low-molecular-weight heparin.

This study of the RIETE Group has been published in the journal Clinical Pharmacology and Therapeutics.