Safety and efficacy of target-specific anticoagulants in patients with venous thromboembolism.

Objective: To review the role of target-specific anticoagulants (TSACs) for the treatment of venous thromboembolism (VTE) and their associated efficacy and safety.

Data Sources: Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE (1966 to November 2014) using the following search terms: venous thromboembolism, vitamin K antagonist (VKA), target-specific anticoagulant, deep-vein thrombosis, pulmonary embolism. Results were limited to human trials published in English. Citations from articles were reviewed for additional references.

Study Selection And Data Extraction: Clinical trials evaluating VTE treatment were included. Trials that evaluated alternative end points were excluded.

Data Synthesis: Patients with VTE have a high risk of developing recurrent events and subsequent death if not treated in an appropriate manner. TSACs have been evaluated in several large clinical trials in patients with acute VTE. These trials have shown positive outcomes when compared with VKAs for treatment of VTE in the general population. Paralleled with these results, TSACs had similar or lower rates of bleeding compared with VKAs.

Conclusions: Taken together, available evidence suggests that TSACs produce similar clinical benefits with less bleeding incidence when compared with VKAs in the treatment of VTE. There are significant differences between each study investigating this class of medication for VTE treatment. Each TSAC has potential advantages, and to date, there has been no head-to-head trial comparing them.