Direct Oral Anticoagulants for Acute Venous Thromboembolism

In the past decades, the two-stage treatment of initial parenteral heparin followed by vitamin K antagonists (VKA) has been the standard therapy for patients with acute venous thromboembolism (VTE). With the advent of direct oral anticoagulants (DOACs), previously known as n ew or n on-VKA oral anticoagulants (NOACs), this era has come to an end. In this issue of Circulation , Schulman et al. report on the results of the RE-COVER II study that investigated the efficacy and safety of dabigatran for the treatment of acute VTE1. The study included patients with acute deep vein thrombosis (DVT) and pulmonary embolism (PE) who were treated for 6 months with dabigatran 150 mg twice daily or warfarin targeted to an international normalized ratio (INR) between 2 and 3, after initial parenteral heparin, mostly low-molecular-weight heparin (LMWH). The study shows that parenteral heparin followed by dabigatran was as effective as heparin overlapped with and followed by warfarin. The primary endpoint of recurrent symptomatic VTE occurred in 2.3% of patients randomized to dabigatran and in 2.2% of patients randomized to warfarin. Moreover, bleeding was less frequent in the dabigatran group. Thus, the RE-COVER II study confirms the results of the RE-COVER study with an identical design.2