New Class of Medication Yields Better Outcomes: Direct Oral Anticoagulants Improve Treatment Success for Lower Extremity Acute Deep Vein Thrombosis

Optimal therapy for acute lower extremity deep venous thrombosis (DVT) remains an enigma. While clinical trials demonstrate noninferiority with oral anti-Xa inhibitor, or direct anticoagulant (DOAC), versus combined low-molecular-weight heparin and vitamin K agonist (VKA), the most effective regimen to be determined. This study is a single-center retrospective review conducted from October 2014 December 2015 of patients diagnosis DVT subsequent serial duplex. Demographics, medical history, medications, ultrasound findings, as well primary used treatment were collected analyzed by two independent data extractors. Successful was defined no new progression existing within 3 months index clot. Risk factors failure assessed using standard odds ratios Fischer’s exact test. Among 496 DVT, 54% (n = 266) men, mean age 61 years, 35% 174) popliteal more proximal clots, 445 had documentation DVT: 21% 93) received nothing, 20% 91) VKA, 34% 150) DOAC, 88) heparin, 5% 21) another class anticoagulant. Within months, 90 427) any prior DVT. Patients treated DOAC less likely experience when compared other (odds ratio, 0.43; 95% confidence interval, 0.23-0.78; P .005), traditional VKA 0.44; 0.21-0.92; .029). A history pulmonary embolism, thrombophilia, renal insufficiency, hepatic cancer, antiplatelet did not correlate failure. Neither number anticoagulants (0-2 vs >2) nor duration (<3 ≥3 months) correlated (P .12 .41, respectively). Proximal distal DVTs showed difference in (19% 22%, respectively; .43). The use yielded better overall outcomes fewer failures at based on duplex imaging.