Direct oral anticoagulants compare favorably with vitamin K antagonists in lowering bleeding rates in patients with sickle cell disease (SCD), according to a study published in Blood Advances.

A major complication of SCD is the risk of venous thromboembolism, which is associated with a higher risk of mortality. Scientists have discovered that all 3 components of Virchow’s triad—blood flow stasis, hypercoagulability, and injury to the vascular wall—have been implicated in the pathogenesis of venous thrombosis. 

For the past few decades, vitamin K antagonists have been used to treat patients with a confirmed diagnosis of venous thromboembolism. However, vitamin K antagonists have considerable limitations, including a short therapeutic window, which requires constant monitoring of the international normalized ratio and potential interactions with other drugs and vitamin K-rich foods.

Direct oral anticoagulants were developed to be safer and more effective alternatives to vitamin K antagonists. Drugs such as dabigatran, rivaroxaban, and apixaban are indicated for the treatment of thrombosis in a number of cardiovascular diseases. 

Read more about SCD etiology 

“Nevertheless, the evidence guiding the management of [venous thromboembolism] in SCD specifically in terms of the anticoagulant of choice is scarce. Therefore, we conducted a systematic review and meta-analysis to address this important question,” the authors explained.

The research team reviewed studies that compared vitamin K antagonists with direct oral anticoagulants in SCD for venous thromboembolism. They conducted a keyword search using academic search engines. A final 7 articles were selected for this study.

“The results of this systematic review and meta-analysis showed lower major bleeding rates and similar [venous thromboembolism] recurrence rates with [direct oral anticoagulant] use compared to [vitamin K antagonists] in patients with SCD, making [direct oral anticoagulants] a reasonable alternative to [vitamin K antagonists] for [venous thromboembolism] in patients with SCD,” the authors concluded.


Rozi WM, Rahhal A, Ali EA, et al. Direct oral anticoagulants in sickle cell disease: a systematic review and meta-analysisBlood Adv. Published online June 21, 2022. doi:10.1182/bloodadvances.2022007308