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Direct oral anticoagulants (DOAC) have performed well against low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) in acutely ill hospitalized medical patients. However, the safety and efficacy of continuing DOAC thromboprophylaxis following discharge has been unclear. To examine this issue, investigators conducted a systematic review and meta-analysis of three clinical trials comparing apixaban, rivaroxaban, or betrixaban with LMWH in more than 22,000 patients.
Extended DOAC was more effective than LMWH in preventing VTE (4.30% of patients vs. 5.61%, P<0.0001), as well as symptomatic VTE (1.11% vs. 1.68%, P=0.002; number needed to treat, 176). However, patients receiving DOAC had higher rates of bleeding (4.82% vs.…