A Saudi Heart Association Position Statement on the use of DOACs in Patients With Arterial and Venous Thrombosis.
Waleed Alhabeeb, Adel Tash, Ahmed Aljedai, Ayman Morsy, Feras Khaliel, Iman Alhazmi, Mohammed AlSheef, Mohammed Arafah, Owayed Alshammeri, Saeed AlAhmari
Author Information
Waleed Alhabeeb: Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
Adel Tash: National Heart Center, Saudi Health Council, Riyadh, Saudi Arabia.
Ahmed Aljedai: Department of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia.
Ayman Morsy: Department of Cardiology, Ministry of Health, Al Noor Specialist Hospital, Makkah, Saudi Arabia.
Feras Khaliel: Department of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Iman Alhazmi: Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Mohammed AlSheef: Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.
Mohammed Arafah: Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
Owayed Alshammeri: Department of Cardiology, Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia.
Saeed AlAhmari: Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Background: Direct oral anticoagulants (DOACs) have emerged as non-inferior and effective alternatives to traditional anticoagulants in managing thromboembolic risks associated with various cardiovascular conditions. This position statement by the Saudi Heart Association (SHA) aims to provide guidance on the use of DOACs in the context of cardiovascular disease, particularly patients with arterial and venous thrombosis. Methods: A multidisciplinary panel of experts reviewed current evidence and international guidelines on DOACs, considering the local healthcare context in Saudi Arabia. The statement addresses the initiation, maintenance, interruption, and re-initiation of DOAC therapy across different patient populations. Results: DOACs are effective alternatives to traditional anticoagulants with a comparable or lower risk of bleeding and no requirement for frequent monitoring, making them more convenient for patients. It is important to regularly assess stroke risk (CHA2DS2-VASc score) and bleeding risk (HAS-BLED score) before initiating DOAC therapy and during the course of treatment, particularly in patients with changing clinical conditions. Specific factors warrant careful consideration for the use of DOACs in special patient populations. Recommendations are therefore provided for dosing adjustments in renal and hepatic impairment, alongside considerations for patients in different clinical scenarios such as those undergoing surgery or with malignancies. Conclusion: DOACs represent a valuable option for clinicians owing to their efficacy, safety and convenience compared to traditional anticoagulants. DOACs should be used based on individualized patient assessment, particularly regarding bleeding risk, stroke risk, and other comorbidities and clinical factors that may affect clinical outcomes. Adherence to the recommendations and guidance provided in this SHA statement is needed to enhance patient care and outcomes in Saudi Arabia.
