Administration of direct oral anticoagulants in patients with myeloproliferative neoplasms

Abstract

Direct oral anticoagulants (DOACs) have been approved to treat and prevent thrombotic events. However, they are not yet labeled for use in patients with active cancers. Myeloproliferative neoplasms (MPNs) are clonal chronic disorders with a high incidence of thrombotic events, for which low-dose aspirin (LDA) is the standard drug treatment. We analyzed efficacy and safety of DOACs prescription in patients treated for MPNs. An MPN database, the OBENE registry, was established at our institution. We collected biological and clinical data from diagnosis to last follow-up for every patient included in this study. Thrombotic and hemorrhagic events and hematologic evolutions were categorized as major events in the database. Of the 760 MPN patients in the OBENE registry, 25 (3.3%) were treated with a DOAC. Median follow-up duration was 2.1 years (0.12-4.3 years). The reasons for prescribing DOACs were atrial fibrillation and thrombotic events for 13 and 12 patients, respectively. We only observed one thrombotic event (4%) and three major hemorrhagic events (12%). A case-control study did not detect a significant difference in thrombotic or hemorrhagic events in patients treated with LDA and DOACs. These preliminary results suggest that DOACs may be highly efficient and safe for use in MPN patients.

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

“…In conclusion, our results from a small cohort study showed that in those with MPN and previous VTE, the use of DOACs was associated with very low/no recurrence rates of VTE and no major bleeding complications. These data are in line with the currently limited literature whereby studies demonstrate the efficacy and safety of DOACs, with a reduction in recurrence rates of thrombosis (Ianotto et al , ; De Stefano et al , ). Our data show that those with unusual sites of VTE, including splanchnic vein thromboses and cerebral venous sinus thrombosis, had no recurrent VTE with the use of DOACs.…”

A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis

“…Direct oral anticoagulants (DOACs) are increasingly used in the non‐MPN population for prophylaxis and VTE therapy. However, there is limited data for their specific use in MPN, where they appear to be safe and efficacious (Ianotto et al , ).…”

“…The management of pruritus is challenging. Symptoms can improve or resolve with control of blood counts, using venesection alone or with cytoreductive therapy (Le Gall- Ianotto et al, 2017). Improvement in pruritus has been reported with hydroxycarbamide (Sharon et al, 1986), interferon (although this drug can also worsen pruritus) (Lengfelder et al, 2000), busulfan and 32 P (Jackson et al, 1987).…”

Pathogenesis and Management of Thrombotic Disease in Myeloproliferative Neoplasms

“…The evidence on use of DOACs in MPN is limited to small number of patients (25 patients) where they appear to be safe and efficacious. 31 Therefore, use of these anticoagulants should be considered only in case-by-case basis by assessing the risk of bleeding versus thrombosis (►Fig. 2).…”