Outcomes of patients receiving direct oral anticoagulants for myeloproliferative neoplasm‐associated venous thromboembolism in a large tertiary centre in the UK

Garcia, Natalia Curto; Doyle, Andrew J.; Breen, Karen; McLornan, Donal; Radia, Deepti; Hunt, Beverley J.; Ling, Gavin; Harrison, Claire

doi:10.1111/bjh.16485

Cited by 25 publications

(39 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In summary, our results complement the currently limited literature [21][22][23]32] on the efficacy and safety of DOACtreated MPN patients. Despite the limitations-small number of patients, retrospective analysis, and short treatment timeour data suggest that the use of DOAC was as effective and safe as VKA.…”

Section: Discussionsupporting

confidence: 81%

Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms

et al. 2020

View full text Add to dashboard Cite

In patients with BCR-ABL-negative myeloproliferative neoplasms (MPN), arterial or venous thromboembolic events (ATE/VTE) are a major burden. In order to control these complications, vitamin K antagonists (VKA) are widely used. There is no robust evidence supporting the use of direct oral anticoagulants (DOAC) in MPN patients. We therefore compared the efficacy and safety of both anticoagulants in 71 cases from a cohort of 782 MPN patients. Seventy-one of 782 MPN patients (9.1%) had ATE/VTE with nine ATE (12.7%) and 62 VTE (87.3%). Forty-five of 71 ATE/VTE (63.4%) were treated with VKA and 26 (36.6%) with DOAC. The duration of anticoagulation therapy (p = 0.984), the number of patients receiving additional aspirin (p = 1.0), and the proportion of patients receiving cytoreductive therapy (p = 0.807) did not differ significantly between the VKA and DOAC groups. During anticoagulation therapy, significantly more relapses occurred under VKA (n = 16) compared to DOAC treatment (n = 0, p = 0.0003). However, during the entire observation period of median 3.2 years (0.1–20.4), ATE/VTE relapse-free survival (p = 0.2) did not differ significantly between the two anticoagulants. For all bleeding events (p = 0.516) or major bleeding (p = 1.0), no significant differences were observed between VKA and DOAC. In our experience, the use of DOAC was as effective and safe as VKA, possibly even potentially beneficial with a lower number of recurrences and no increased risk for bleedings. However, further and larger studies are required before DOAC can be routinely used in MPN patients.

show abstract

Section: Discussionsupporting

confidence: 81%

Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms

et al. 2020

View full text Add to dashboard Cite

show abstract

“…We demonstrated the efficacy of DOACs in this setting of patients: no thrombotic events were observed. We included patients at high thrombotic risk, such as patients with myeloproliferative disorders 48,49 and patients with MM on immunomodulant agents 5,9 . The use of DOACs appears to be effective in both VTE and AF; this is an important observation, considering that there is no solid evidence regarding how to manage AF in cancer patients 50 .…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants in patients with hematologic malignancies

Serrao

Fiori

Santoro

et al. 2020

Hematological Oncology

View full text Add to dashboard Cite

The anticoagulant treatment for patients with hematologic malignancies is low molecular weight heparin (LMWH), which is considered the safest in this particular patients setting. Although direct oral anticoagulants (DOACs) have proven their efficacy and safety in patients with cancer, their use can be challenging in patients with hematologic malignancies due to the peculiarity of these neoplasms: high thrombotic risk, possible onset of thrombocytopenia and concomitant anticancer therapies. The aim of our study was to evaluate the efficacy and safety of DOACs for venous thromboembolism or atrial fibrillation in patients with hematologic malignancies and plasmatic DOACs level during anticancer therapy and at time of bleeding or thrombotic complications. We evaluated patients with hematologic malignancies treated with DOACs for venous thromboembolism or atrial fibrillation-therapy was maintained until the platelet count was ≥50 × 10 9 /L. In case of concomitant anticancer treatment and haemorrhagic or thrombotic events, we checked DOACs plasma levels (trough and peak). The patients evaluated were 135: 104/135 were on anticancer therapy. We did not observe either thrombotic or major haemorrhagic adverse events. Minor bleedings occurred in 10 patients and clinical relevant non-major (CRNM) in two patients. There was a statistically significant correlation between bleedings and myelodysplastic syndrome. DOACs resulted effective and safe in patients with hematologic malignancies. DOACs plasma level can be helpful in suggesting an early dose adjustment to prevent haemorrhagic adverse event in patients on concomitant anticancer therapy. Larger prospective studies including hematologic patients are warranted to confirm the safety and efficacy of DOACs.

show abstract

“…89 Very recently, two studies were published on this issue. 90,91 A retrospective English study evaluated 32 patients with MPN-associated VTE, including SVT and cerebral thrombosis, receiving DOACs (17 rivaroxaban, 14 apixaban, and 1 edoxaban). 90 During the follow-up, there were no VTE recurrences in 31 patients, and only one case had evidence of mesenteric ischemia.…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Prevention and Management of Thrombosis in BCR/ABL-Negative Myeloproliferative Neoplasms

2021

View full text Add to dashboard Cite

Myeloproliferative neoplasms (MPNs) are clonal disorders of the hematopoietic stem cell. Classical BCR/ABL-negative MPNs include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Thrombotic events are a major cause of morbidity and mortality in these patients. Pathogenesis of blood clotting activation involves various abnormalities of platelets, erythrocytes, and leukocytes, as well as dysfunctions of endothelial cells. Patients with MPN can be stratified in “high risk” or “low risk” of thrombosis according to established risk factors. ET and PV clinical management is highly dependent on the patient's thrombotic risk, and a risk-oriented management strategy to treat these diseases is strongly recommended. In this review, we give an overview of risk factors, pathogenesis, and thrombosis prevention and treatment in MPN.

show abstract

Outcomes of patients receiving direct oral anticoagulants for myeloproliferative neoplasm‐associated venous thromboembolism in a large tertiary centre in the UK

Cited by 25 publications

References 10 publications

Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms

Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms

Direct oral anticoagulants in patients with hematologic malignancies

Prevention and Management of Thrombosis in BCR/ABL-Negative Myeloproliferative Neoplasms

Contact Info

Product

Resources

About