New anticoagulants

In recent years four new direct action anticoagulants (DOACs) prescribed for the treatment of VTE have become available: rivaroxaban (trading name: Xarelto®), dabigatran (Pradaxa®), apixaban (Eliquis®) and edoxaban (Lixiana®)

These NOACs are administered orally once or twice daily which is more comfortable for the patient. Unlike other anitcoagulant treatments, they do not require routine controls to adjust the dose.

This means lower transportation costs, less time spent for patients and their companions to travel to and fro health centers, as well as reduced hospital stays for low risk patients who continue their treatment at home from day one on. Besides, these drugs barely interfere with food.

The clinical practice guidelines of the American College of Chest Physicians (ACCP) and the Spanish consensus documents for the treatment of PE recommend the use of oral anticoagulants for direct action over vitamin K antagonists in the treatment of patients with VTE.

Random clinical trials have shown that these four drugs present an efficacy similar to the routine treatment (with low molecular weight heparin and antivitamin K), yet being safer. In other words, the same relapses with a lower bleeding rate have been recorded.

The American College of Chest Physicians (ACCP) clinical practice guidelines and the Spanish Consensus document for the treatment of PE support the use of direct-acting oral anticoagulants over vitamin K antagonists in the treatment of patients with VTE.

Safer and more convenients

Randomised clinical trials have shown that these four drugs have similar efficacy to standard treatment (with low molecular weight heparin and antivitamin K) and are safer. In other words, the same recurrences have been reported with a lower rate of bleeding.

Direct-acting anticoagulants are also more convenient, as they do not require regular visits to the health centre to adjust the dose. This means less travel costs, less time wasted for patients, caregivers and doctors, and ultimately greater patient satisfaction.

And because they are administered in fixed doses and orally, they also make it possible to reduce hospital stays and to continue treatment at home from day one in low-risk patients.

Errors and discrimination in the administration of ACODs

A study by RIETE Group researchers shows that treatment with the new oral anticoagulants is not being given in the right doses or regimens in one in eight patients with venous thromboembolic disease (VTE).

Comparing the data between patients who were mismedicated and patients who were on the right treatment, the scientists found that the wrong medication led to more recurrences, with the same bleeding and the same deaths. And they calculated that at least 15% of anticoagulated VTE patients do not receive adequate doses of treatment.

In addition, patients at risk of bleeding are left out of clinical trials that are conducted before an OACD is brought to market. This has been shown in another study by the RIETE Group, which found that pregnant women, people with disseminated cancer, liver cirrhosis, severe renal failure, low blood platelets and patients with a recent history of severe bleeding react to direct-acting anticoagulants in a similar way to patients without special characteristics.