Various clinical literature on using direct oral anticoagulants (DOACs) therapy for non-Food and Drugs Administration approved indications was assessed in this review article.
From 1946 to September 4, 2020, articles from the MEDLINE, Cochrane Library, Google Scholar, and OVID databases were examined. DOACs for atrial fibrillation (AF) with valvular heart disease (VHD), heart failure (HF), superficial vein thrombosis (SVT), left ventricular thrombus (LVT), or pulmonary hypertension (PH) were evaluated from fully published studies.
With the exception of mitral stenosis and mechanical heart valves, DOACs were found to be safe for use in patients with atrial fibrillation (AF) and VHD. Until further evaluation is performed, caution should be taken while using rivaroxaban 2.5mg twice daily in HF patients with reduced ejection fraction. Inconclusive results on the use of DOACs in patients with LVT were found in four retrospective studies. Rivaroxaban was found to be non-inferior to fondaparinux for SVT treatment in one phase 3 randomized controlled trial. There was no clinical study that looked at the use of DOACs for pulmonary arterial hypertension. Similar effectiveness was found between DOACs and warfarin for the treatment of patients with chronic thromboembolic PH(CTEPH) in two retrospective studies.
Clinicians are provided with a thorough literature review on the use of DOACs in common off-label indications, with the help of this review article. Except for mitral stenosis or mechanical valve replacement, DOACs can be considered for AF complicated by VHD. Among various DOACs, rivaroxaban in particular can be used as an alternative treatment in patients with SVT and CTEPH.