Direct Oral Anticoagulants for the Treatment of Unusual-Site Venous Thrombosis: An Update

Direct oral anticoagulants (DOACs) have emerged as the preferred oral anticoagulant therapy for patients with deep vein thrombosis of the lower extremities and pulmonary embolism. DOACs offer several advantages over vitamin K antagonists, including fixed dosage, fewer drug interactions, faster onset of action, and a lower risk of major bleeding, especially intracranial. Although evidence on the use of DOACs in unusual-site venous thrombosis (USVT) is limited, their use in such cases is becoming increasingly common. This narrative review examines the evidence derived from randomized controlled trials, and large observational studies focused on the use of the DOACs in USVT, including cerebral, splanchnic, upper extremity, ovarian, renal, and retinal vein thrombosis. In addition, it also provides practical advice for their use in these clinical settings according to the updated scientific literature.