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Bleeding and spontaneous ecchymosis: 10 case reports In a retrospective study of 135 patients conducted between January 2014 and December 2019, ten patients [ages and sexes not stated] were described, who developed bleeding or spontaneous ecchymosis during treatment with apixaban, edoxaban, ibrutinib, imatinib, nilotinib, dabigatran etexilate or rivaroxaban for haemorrhagic malignancies, atrial fibrillation or as an anticoagulants. The patients had non-Hodgkin lymphoma (2 patients), myelodysplastic syndrome (1 patient), myelodysplastic syndrome and atrial fibrillation (1 patient), Hodgkin lymphoma (1 patient), acute myeloid leukaemia and atrial fibrillation (1 patient) and unspecified haemorrhagic malignancies (4 patients). They started receiving ibrutinib and oral edoxaban (2 patients), imatinib and oral edoxaban (1 patient), nilotinib and oral rivaroxaban (1 patient), oral apixaban (4 patients), oral edoxaban (1 patient) and oral dabigatran etexilate [dabigatran; 1 patient; dosages not stated; not all routes stated]. Subsequently, the patients developed treatment-related adverse events including bleeding (8 patients) and spontaneous ecchymosis [2 patients; duration of treatments to reaction onsets not stated]. In 8 of the 10 patients, the peak plasma levels of direct oral anticoagulants ranged between 133–428 ng/mL and trough levels ranged between 52–276 ng/mL. The treatment with direct oral anticoagulants was switched to unspecified low molecular weight heparins in 6 patients after resolution of the bleeding events. The remaining 4 patients continued direct oral anticoagulants due to spontaneous resolution of the bleeding events and normal plasma levels. The 6 patients, whose treatment was switched, were re-initiated at a reduced dose of direct oral anticoagulants, after which the plasma levels were in the expected ranges. Serrao A, et al. Direct oral anticoagulants in patients with hematologic malignancies. Hematological Oncology 38: 589-596, No. 4, Oct 2020. Available from: URL: http:// 803520957 doi.org/10.1002/hon.2770

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Reactions 12 Dec 2020 No. 1834