Non-Vitamin K antagonist oral anticoagulants and novel catheter-based interventional devices in pulmonary thromboembolism

This systematic bibliographic review evaluates the published literature on non-vitamin K antagonist oral anticoagulants (NOACs) and catheter-based interventional devices in pulmonary thromboembolism (PTE) treatment, comparing outcomes from Turkey and worldwide (2014–2024). A systematic search compliant with PRISMA 2020 guidelines was conducted across PubMed, Cochrane Library, Embase, and the Turkish Medical Index (January 2014–December 2024). Randomized controlled trials (RCTs), registries, and meta-analyses were included, with quality assessments performed utilizing the GRADE methodology. This review provides a narrative synthesis of published evidence rather than conducting a new meta-analysis. Analysis of 142 studies involving more than 75,000 patients showed that NOACs achieve non-inferior efficacy and a 40–69% reduction in major bleeding compared with vitamin K antagonists (VKAs). The AMPLIFY trial reported a 69% reduction in bleeding with apixaban. The Turkish NOAC-TURK registry (n=2,862) reported an overall bleeding rate of 7.6% but identified a concerning 47.6% rate of inappropriate dose reduction. Regarding catheter-directed therapies, the PEERLESS trial (2024) demonstrated that FlowTriever mechanical thrombectomy was superior to catheter-directed thrombolysis (CDT), with a win ratio of 5.01 (p<0.001) and markedly reduced intensive care unit (ICU) utilization (41.6% vs. 98.6%). NOACs represent Level I evidence for PE anticoagulation. Mechanical thrombectomy shows promise with superior resource utilization profiles. In Turkey, multicenter PE registries and NOAC dosing education programs are needed to optimize patient outcomes.