Direct Oral Anticoagulants in Antithrombin Deficiency: Initial Experience in a Single Center

Bhoelan, B. Soerajja; Mulder, René; Lukens, Michaël V.; Meijer, Karina

doi:10.1055/s-0040-1715647

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…A study of 10 patients receiving rivaroxaban showed no recurrence after a mean follow up of 1.7 years. 12 A metaanalysis of eight randomised controlled trials of DOACs included 15 patients with IATD; none of whom had recurrence, in a limited follow-up of 6-12 months. 11 This article is protected by copyright.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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The Efficacy and Safety of DOACs in Inherited Antithrombin Deficiency: A Cohort Study from a Tertiary Referral Center

Dix,

Doyle,

Breen

et al. 2024

Thromb Haemost

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Individuals with inherited antithrombin deficiency (IATD) have a high risk of venous thromboembolism (VTE). Most VTE are managed with direct oral anticoagulants (DOACs), but the utility of DOACs in ATD is unreported. Patients with IATD treated with DOAC were identified from our institutions’ IATD registry. We assessed patients’ characteristics, ATD type, and initial VTE characteristics, thrombosis recurrence and bleeding rates. Thirty-three patients received DOACs for 73 (38.5, 111.5) months (median (IQR)). Prior to taking DOACs, 12 (36%) patients had VTE recurrence: these occurred after anticoagulation was ceased (four), nonadherence to VKA prior to DOAC use (3), or during heparin use in pregnancy (5). There were no VTE recurrences on standard dose DOAC, except in a noncompliant patient receiving dabigatran. There was one recurrence with compliant DOAC use – a patient receiving rivaroxaban 10mg. Six (18%) patients experienced clinically-relevant bleeding, which was predominantly menorrhagia (5/6). One major bleeding event, intracranial haemorrhage, occurred in a patient receiving full-dose rivaroxaban who had refractory hypertension (0.5 events/100 patient-years). In this cohort, compliant DOAC users had an overall VTE recurrence rate of 0.5/100-patient years, whereas with low-dose DOACs the event rate was 3.5/100-patient years. In conclusion standard dose DOACs appears efficacious and relatively safe in IATD.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…However, clinical evidence for the use of DOACs in those with IATD is limited to small case series and reports. 11,12 Individuals with known IATD were not included in the DOAC trials, probably due to its rarity and/or possible concerns that DOACs would not be effective in overcoming the prothrombotic state of IATD.…”

mentioning

confidence: 99%

The Efficacy and Safety of DOACs in Inherited Antithrombin Deficiency: A Cohort Study from a Tertiary Referral Center

Dix,

Doyle,

Breen

et al. 2024

Thromb Haemost

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“…No recurrences have been reported. [18][19][20] Ten different families with hereditary AT deficiency are registered at our institution. Most of the family members require indefinite anticoagulation owing to thrombosis development.…”

Section: Introductionmentioning

confidence: 99%

Antithrombin Deficiency and Thrombosis: A Wide Clinical Scenario Reported in a Single Institution

Marco-Rico,

Marco-Vera

2023

JBM

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Congenital antithrombin (AT) deficiency represents the form of thrombophilia with the highest thrombotic risk. It is characterized by a heterogeneous clinical presentation, depending mostly on the family history of thrombosis and type of genetic mutation. Inherited AT deficiency promotes idiopathic thrombosis at an early age (even in the pediatric population) and at atypical sites. Therefore, a positive family background necessitates ruling out this high-risk thrombophilia at a young age. Studying first-degree relatives, even if they are asymptomatic, is essential to establish thromboprophylaxis and a proper therapeutic approach in case of thrombosis. Patients with congenital AT deficiency require indefinite anticoagulation owing to the high thrombotic recurrence rate. Here, we present four unrelated cases reported in our institution who were diagnosed with hereditary AT deficiency, with a contrasting clinical evolution.

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Hereditary antithrombin deficiency pilot project registry from the American Thrombosis and Hemostasis Network

DeSancho,

Suvar,

Roberts

et al. 2024

Journal of Thrombosis and Haemostasis

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Direct Oral Anticoagulants in Antithrombin Deficiency: Initial Experience in a Single Center

Cited by 4 publications

References 14 publications

The Efficacy and Safety of DOACs in Inherited Antithrombin Deficiency: A Cohort Study from a Tertiary Referral Center

The Efficacy and Safety of DOACs in Inherited Antithrombin Deficiency: A Cohort Study from a Tertiary Referral Center

Antithrombin Deficiency and Thrombosis: A Wide Clinical Scenario Reported in a Single Institution

Hereditary antithrombin deficiency pilot project registry from the American Thrombosis and Hemostasis Network

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