Effectiveness and safety of oral anticoagulants in patients with sickle cell disease and venous thromboembolism: a retrospective cohort study

Roberts, Megan Z.; Gaskill, G. Eric; Kanter-Washko, Julie; Kyle, T. Rogers; Jones, Brittany C.; Bohm, Nicole

doi:10.1007/s11239-018-1637-y

Cited by 16 publications

(10 citation statements)

References 29 publications

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“…Of those on warfarin, 1 of 15 patients (7%) developed major bleeding and 2 of 15 (13%) developed nonmajor bleeding. 121 In another cohort study of individuals with SCD on anticoagulation (n 5 877), the cumulative incidence of bleeding was 4.9% (95% CI, 3.5%-6.4%) at 6 months and 7.9% (95% CI, 6.2%-9.8%) at 1 year. 123 Benefits, harms, and burden.…”

Section: Indefinite Anticoagulation Is Not Recommended For Firstmentioning

confidence: 95%

“…A total of 3 published studies reported on safety of anticoagulation in adults with SCD. [121][122][123] In a retrospective study of patients with SCD receiving VTE prophylaxis (n 5 116), anticoagulation was discontinued for hemorrhage in 5 of 116 patients (4.3%). 122 In a small retrospective cohort study of patients receiving oral anticoagulants (n 5 37), 3 of 22 patients (14%) receiving direct oral anticoagulants developed nonmajor bleeding and none developed major bleeding.…”

Section: Indefinite Anticoagulation Is Not Recommended For Firstmentioning

confidence: 99%

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American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

et al. 2019

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Background: Prevention and management of end-organ disease represent major challenges facing providers of children and adults with sickle cell disease (SCD). Uncertainty and variability in the screening, diagnosis, and management of cardiopulmonary and renal complications in SCD lead to varying outcomes for affected individuals. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews up to September 2017. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 10 recommendations for screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Recommendations related to anticoagulation duration for adults with SCD and venous thromboembolism were also developed. Conclusions: Most recommendations were conditional due to a paucity of direct, high-quality evidence for outcomes of interest. Future research was identified, including the need for prospective studies to better understand the natural history of cardiopulmonary and renal disease, their relationship to patient-important outcomes, and optimal management.

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Section: Indefinite Anticoagulation Is Not Recommended For Firstmentioning

confidence: 95%

Section: Indefinite Anticoagulation Is Not Recommended For Firstmentioning

confidence: 99%

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

et al. 2019

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“…A recently published single institution retrospective study of 37 SCD patients with VTE, treated with anticoagulation, revealed a high incidence of recurrence and bleeding . Nine patients developed VTE recurrence within six months of the index event (24%).…”

Section: Discussionmentioning

confidence: 99%

High incidence of venous thromboembolism recurrence in patients with sickle cell disease

et al. 2019

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Previous reports show increased incidence of venous thromboembolism [VTE, deep‐vein thrombosis (DVT) and pulmonary embolus (PE)] in sickle cell disease (SCD) patients. The incidence, time course, and risk factors for VTE recurrence have been less well described. We determined the cumulative incidence of first VTE recurrence and bleeding in a cohort of SCD patients with incident VTE. Risk factors for recurrence and bleeding were also determined using multivariable Cox regression models, adjusting for gender, race/ethnicity, era of incident VTE, location and hospitalization‐associated status of incident VTE, and SCD‐related complications. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Among 877 SCD patients with an incident VTE, the 1‐year and 5‐year cumulative incidence of recurrence was 13.2% (95% CI 11.0%‐15.5%) and 24.1% (95% CI 21.2%‐27.1%). Risk factors for VTE recurrence included more severe SCD (HR = 2.41; CI: 1.67‐3.47), lower extremity DVT as the incident event (HR = 1.64; CI: 1.17‐2.30), and pneumonia/acute chest syndrome (HR = 1.68; CI: 1.15‐2.45). The cumulative incidence of bleeding was 4.9% (CI 3.5%‐6.4%) at 6 months and 7.9% (CI: 6.2%‐9.8%) at 1 year. More severe SCD (HR = 1.61; CI: 1.11‐2.35) was associated with bleeding. The high incidence of VTE recurrence in patients with SCD suggests that extended anticoagulation may be indicated; however, this must be weighed against a relatively high risk of bleeding. Prospective, randomized studies of anticoagulation in SCD patients with VTE are needed.

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“…Three types of anticoagulation have been tested. 59 Warfarin and acenocoumarin reduce the markers of coagulation activation but have no effect on the frequency of painful episodes. Low molecular weight heparin (HPBM) decreases the severity of painful crises and, as a consequence, the duration of hospital stay.…”

Section: Results (Recommendations and Guidelines)mentioning

confidence: 99%

Total hip arthroplasty for sickle cell osteonecrosis: guidelines for perioperative management

et al. 2020

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The prognosis of sickle cell disease (SCD) has greatly improved in recent years, resulting in an increased number of patients reporting musculoskeletal complications such as osteonecrosis of the femoral head. Total hip arthroplasty (THA) can be utilized to alleviate the pain associated with this disease. Although it is well known that hip arthroplasty for avascular necrosis (AVN) in SCD may represent a challenge for the surgeon, complications are frequent, and no guidelines exist to prevent these complications. Because patients with SCD will frequently undergo THA, we thought it necessary to fulfil the need for guidance recommendations based on experience, evidence and agreement from the literature. For all these reasons this review proposes guidelines that provide clinicians with a document regarding management of patients with SCD in the period of time leading up to primary THA. The recommendations provide guidance that has been informed by the clinical expertise and experience of the authors and available literature. Although this is not a systematic review since some papers may have been published in languages other than English, our study population consisted of 5,868 patients, including 2,126 patients with SCD operated on for THA by the senior author in the same hospital during 40 years and 3,742 patients reported in the literature. Cite this article: EFORT Open Rev 2020;5:641-651. DOI: 10.1302/2058-5241.5.190073

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Effectiveness and safety of oral anticoagulants in patients with sickle cell disease and venous thromboembolism: a retrospective cohort study

Cited by 16 publications

References 29 publications

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

High incidence of venous thromboembolism recurrence in patients with sickle cell disease

Total hip arthroplasty for sickle cell osteonecrosis: guidelines for perioperative management

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