The great discovery of DOACs and why physicians insist on misusing it: A paradox of the 21 century

A Descriptive Analysis of Direct Oral Anticoagulant Drugs Dosing Errors Based on Spontaneous Reports from the EudraVigilance Database

“…A variation between 0.07% (dabigatran) and 2.32% (apixaban) ( Figure 2 ) was observed regarding the distribution of this ADR in the total number of reports. Several research groups have also underlined the frequent off-label underdosing for DOACs [ 31 , 55 , 56 , 57 ].…”

Another meta-analysis on novel oral anticoagulants for left ventricular thrombus: when enough is enough?

“…Nonvitamin K oral anticoagulants (NOAC) were firstly introduced in 2008, and interest in their possible role in treating multiple thrombotic illnesses has been growing ever since. 1 Although many systematic reviews have already appraised in detail the risk-benefit balance of NOAC in various clinical setting, left ventricular thrombus represents a relatively orphan topic, wherein vitamin-K antagonists (VKA) are still considered the default treatment strategy. 2,3 Indeed, NOAC appear promising in several settings, but their role, whenever anatomic conditions represent a key pathophysiologic underpinning of thrombosis, is less established, as highlighted by the recent disappointing results of the INVICTUS trial comparing rivaroxaban versus VKA in patients with atrial fibrillation and rheumatic heart disease.…”

“…In the meanwhile, despite a not perfectly stable balance in the VKA versus NOAC comparison, current knowledge seems solid enough to avert the well documented physicians' uncertainty in NOAC administration. 1 Hence, a pragmatic approach should best be sought, with VKA being considered the standard of care for LVT, and a low threshold to shift to NOAC applied in case contraindications (even relative ones) are present for VKA.…”

“…Nonvitamin K oral anticoagulants (NOAC) were firstly introduced in 2008, and interest in their possible role in treating multiple thrombotic illnesses has been growing ever since 1 . Although many systematic reviews have already appraised in detail the risk--benefit balance of NOAC in various clinical setting, left ventricular thrombus represents a relatively orphan topic, wherein vitamin-K antagonists (VKA) are still considered the default treatment strategy 2,3 .…”

“…Accordingly, more detailed and accurately stratified pooled analyses could provide higher quality information, but the only viable option for obtaining ultimately conclusive evidence is the completion of a large, rigorous and double-blind randomized controlled trial, focusing on risk-effectiveness as well as cost-effectiveness. In the meanwhile, despite a not perfectly stable balance in the VKA versus NOAC comparison, current knowledge seems solid enough to avert the well documented physicians’ uncertainty in NOAC administration 1 . Hence, a pragmatic approach should best be sought, with VKA being considered the standard of care for LVT, and a low threshold to shift to NOAC applied in case contraindications (even relative ones) are present for VKA.…”