Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myel
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ORIGINAL ARTICLE
Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms Karlo Huenerbein 1 & Parvis Sadjadian 1 & Tatjana Becker 1 & Vera Kolatzki 1 & Eva Deventer 1 & Carina Engelhardt 2 & Martin Griesshammer 1 & Kai Wille 1 Received: 3 November 2020 / Accepted: 11 November 2020 # The Author(s) 2020
Abstract 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 relapsefree 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. Keywords Myeloproliferative neoplasms . Direct oral anticoagulants . Thrombosis . Anticoagulation therapy . Bleeding
Introduction In patients with BCR-ABL-negative myeloproliferative neoplasms (MPN), arterial and venous thromboembolic events (ATE/VTE) occur frequently and have a significant impact
on morbidity and mortality [1–3]. Several studies reported up to 10 times higher incidence of such complications compared to the healthy population [4–12]. Vitamin K antagonists (VKA) are widely used for both primary therapy and secondary prevention of MPN-
* Karlo Huenerbein [email protected]
Carina Engelhardt [email protected] Martin Griesshammer [email protected]
Parvis Sadjadian [email protected]
Kai Wille [email protected]
Tatjana Becker [email protected] 1
University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Min
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