European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism
BMC primary care · 2024 · DACH
Source and licence
- Authors
- Carter Patrice, Fuat Ahmet, Haas Sylvia et al.
- Title
- European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism
- Journal
- BMC Primary Care, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10946109
Licence statement of the original publication
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Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Key recommendation
- Concise and simple evidence-based recommendations for the management of VTE patients in primary care are needed to aid optimization of care.
Key recommendations
- DOACs are the treatment of choice for managing patients with VTE.
- DOACs offer an oral treatment that is at least as effective and safe as other anticoagulants (VKA and LMWH).
- DOAC choice should be based on individual patient factors, such as comorbidities and likely adherence.
- The only sub-group of patients who warrant their own specific recommendations on VTE treatment, are those with cancer. DOACs are the treatment of choice for cancer patients with VTE Active cancer is a key consideration when deciding to continue or discontinue anticoagulation treatment for VTE
- DOACs are the treatment of choice for cancer patients with VTE
- Active cancer is a key consideration when deciding to continue or discontinue anticoagulation treatment for VTE
- DOACs are the treatment of choice for managing the initial and extended treatment of VTE patients. Depending on DOAC prescribed, treatment may require a lead in period of LMWH.
- Depending on DOAC prescribed, treatment may require a lead in period of LMWH.
- Initial treatment should be stopped after three to six months if the precipitating factor is no longer present, and the clinical course has been uncomplicated.
- If initial DOAC treatment is not well tolerated, consider switching to an alternative DOAC, or refer to a specialist.
- For DVT and/or PE patients who present with a new VTE event whilst receiving well controlled VKA treatment, LMWH or DOAC therapy can be prescribed, and consideration for referral to a specialist should be considered.
Abstract
Background: Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios.
Methods: A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2.
Results: In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer.
Conclusion: Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12875-024-02314-7.
Contents of the original publication
The section headings of the original.
- Background
- Objective
- Methods
- Results
- Phase 1 participant characteristics
- Current landscape and requirement for consensus recommendations
- DOACs versus other anticoagulants
- Consideration for specific patient populations
- Treatment initiation and duration
- Treatment switching
- Discussion
- Implications for practice
- Strengths and limitations
- Conclusion
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