June 18, 2024

New Study Finds Infarct Size Unrelated to Treatment Outcome When Comparing Early and Late Initiation of Direct Oral Anticoagulants

A recent study published in the American Heart Journal has revealed that the size of a heart infarct, or the area of heart tissue damaged due to a heart attack, does not significantly impact the treatment outcome when comparing early and late initiation of direct oral Anticoagulants (DOACs).

Researchers from the University of California, San Francisco, analyzed data from over 1,500 patients who had experienced an acute coronary syndrome event, including both heart attacks and unstable angina. The patients were divided into two groups based on the timing of DOAC initiation: those who started DOACs within 48 hours of the event (early initiation) and those who started DOACs between 48 hours and 30 days after the event (late initiation).

The study found that there was no significant difference in the rate of major bleeding or thromboembolic events between the early and late initiation groups, regardless of infarct size. The researchers also noted that there was a trend towards a lower risk of major bleeding in the late initiation group, but this difference was not statistically significant.

These findings challenge the current belief that early initiation of DOACs is always preferable, especially in patients with larger infarcts. The study suggests that late initiation of DOACs may be a viable option for certain patients, particularly those who are at higher risk for bleeding or who have contraindications to early initiation.

However, it is important to note that this study does not change the current guidelines for DOAC initiation in all patients. The decision to initiate DOACs early or late should still be based on an individualized assessment of each patient’s risk factors and clinical situation.

The researchers plan to conduct further studies to explore the potential benefits and risks of late initiation of DOACs in different patient populations. In the meantime, clinicians should consider the results of this study when making decisions about DOAC initiation in their patients, particularly those with larger infarcts.

Overall, this study provides important new insights into the role of infarct size in the treatment outcome of early versus late DOAC initiation and may lead to new approaches for managing anticoagulation therapy in patients with acute coronary syndrome.

1. Source: Coherent Market Insights, Public sources, Desk research
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