The number of DOAC (direct acting oral anticoagulants) users has doubled in five years. At the same time, only a quarter of patients are still taking a vitamin K antagonist (VKA) as an oral anticoagulant. Martin Hemels, a cardiologist at Rijnstate in Arnhem and Radboud University Medical Center Nijmegen, finds that the switch to this new generation of anticoagulants is easy to explain.
“Easy to use, that’s the big advantage of DOACs. ” Martin Hemels doesn’t have to think about it for long. “Patients do not need to go to the thrombosis service every time (weekly or monthly) for a check-up. For some patients this was an obstacle to the initiation of anticoagulation. So we saw undertreatment, because people sometimes said: ‘I don’t feel like going to the thrombosis service, just give me an aspirin.’ That’s what we did, but we now know that aspirin does not provide sufficient protection against cerebral infarction, the main indication for anticoagulation medication. Aspirin is also not included in our treatment guidelines.
“DOACs have a 50% lower risk of a dreaded cerebrovascular accident”
Cardiologist Martin Hemels
Safer than VKAs
There is something else: DOACs lead to less risk of cerebral hemorrhage. “All comparative studies between DOACs and VKAs show that DOACs are at least as effective as VKAs. However, DOACs have a 50% lower risk of the dreaded complication of cerebral hemorrhage. Cardiologists decided d
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