Simplified summary
Title: Are direct oral anticoagulants (a type of “blood thinner”) better than traditional anticoagulants for treating pulmonary thromboembolism (blood clots in the lungs)?
What is a pulmonary embolism?
It is when a piece of a blood clot breaks off from another part of the body and travels through the blood to the lungs. This condition can be life-threatening and affects approximately 4 to 12 people per 10,000. Risk factors include previous clots, prolonged immobilization (such as long trips or bed rest), cancer, exposure to estrogen (pregnancy, oral contraceptives, hormone therapy), clotting disorders (thrombophilias), and trauma.
How is pulmonary thromboembolism (PTE) treated?
Until recently, the standard treatment was the use of anticoagulants, commonly known as “blood thinners,” including heparin, fondaparinux, and vitamin K antagonists. However, these drugs can have adverse effects and limitations. For this reason, direct thrombin inhibitors (DTIs) and factor Xa inhibitors have been developed. These anticoagulants are administered orally, have a predictable effect, do not require frequent monitoring or dose adjustments, and have few drug interactions. For these reasons, they have become the preferred option for treating deep vein thrombosis (DVT).
What did we want to find out?
We wanted to know whether direct oral anticoagulants (DOACs) are useful and safe for treating PTE compared with traditional anticoagulants. We analyzed whether treatment for 3 or more months prevents the formation of new clots (venous thromboembolism [VTE], recurrent DVT, and PTE). We also looked at important side effects such as serious bleeding and death.
What did we do?
We searched for studies in which people with PTE confirmed by standard imaging had been randomized to 2 treatment groups. These studies provide the most reliable evidence about the effects of treatments. People in the experimental groups received an IDT or a factor Xa inhibitor, and their outcomes were compared with those who received traditional anticoagulants. All participants received long-term treatment (minimum 3 months).
What did we find?
We included 10 studies with a total of 13,073 participants. The studies compared DOACs and factor Xa inhibitors with conventional anticoagulants. When combining the data, we found no clear differences in terms of recurrence of PTE, recurrence of DVT (blood clot in a deep vein in the leg or pelvis), recurrence of VTE (when DVT and PTE occur), mortality, and major bleeding. This review showed that there are no clear differences between DOACs and conventional treatment in the prevention of PTE, VTE, DVT, mortality, and major bleeding. No studies evaluated quality of life.
What are the limitations of the evidence?
We have moderate confidence in this evidence due to the low number of events and differences between the included studies.
How up to date is the evidence?
This review updates a previous Cochrane review. The evidence is current to March 2022. Key points. Current evidence shows that there is likely to be little or no difference between DOACs and conventional anticoagulation in preventing recurrence of PTE, VTE, DVT, mortality, and major bleeding in people treated for PTE.
Meixuan Li1-3, Jing Li1,2, Xiaoqin Wang4, Xu Hui1,2, Qi Wang3, Shitong Xie3,5, Peijing Yan6, Jinhui Tian1,2, Jianfeng Li7, Ping Xie7, Kehu Yang1,2, Liang Yao3
1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
2Centro de Investigación en Ciencias Sociales Basadas en la Evidencia, Facultad de Salud Pública, Universidad de Lanzhou, Lanzhou, China.
3Departamento de Métodos de Investigación en Salud, Evidencia e Impacto, Facultad de Ciencias de la Salud, Universidad McMaster, Hamilton, Canadá.
4Instituto Michael G DeGroote para la Investigación y el Tratamiento del Dolor, Universidad McMaster, Hamilton, Canadá.
5Facultad de Ciencia y Tecnología Farmacéutica, Universidad de Tianjin, Tianjin, China.
6Departamento de Epidemiología y Estadísticas Sanitarias, Facultad de Salud Pública de China Occidental y Cuarto Hospital de China Occidental, Universidad de Sichuan, Chengdu, China.
7Departamento de Cardiología, Hospital Provincial de Gansu, Lanzhou, China.
Para descargar la investigación completa haga clic a continuación:
https://revistaemergencias.org/wp-content/uploads/2025/06/382-383.pdf
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