A systematic review and meta-analysis recently published by the American College of Chest Physicians has assessed the effects of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) during extended anticoagulation for VTE events, addressing both overall mortality and VTE-related mortality, as well as clot recurrence and overall safety. The study included 12,458 patients, and found that DOACs were associated with reduced overall (risk ratio [RR]: 0.48; 95% CI: 0.27-0.86; P = 0.01) and VTE-related (RR: 0.36; 95% CI: 0.15-0.89; P = 0.03) mortality, but that this was not the case with VKAs (P > 0.50). DOACs and VKAs had similar effects on preventing recurrent VTE, but the risk of major bleeding was increased only with VKAs (RR: 2.67; 95% CI: 1.28-5.60; P < .01). To conclude, the review found evidence linking DOACs with significant decrease in overall mortality and enhanced net clinical benefit during extended use. The full details of the review can be accessed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh