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

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 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.

Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients

“…On the other hand, VKAs partially prevent recurrent venous thromboembolism (VTE), and the incidence of either recurrent thrombosis and major bleeding is still unacceptable high [4].DOACs emerged as a treatment of choice for secondary prevention of VTE and thrombosis prophylaxis in AF in the general population, and may be an attractive alternative to VKAs in MPN. However, evidence of their efficacy and safety in MPN is very limited and based on few retrospective observational studies [3,[5][6][7], and on scattered information from controlled trials of DOACs versus VKAs.…”

Thrombosis in myeloproliferative neoplasms: Treatment outcomes of direct oral anticoagulants and vitamin K antagonists

“…The incidence of recurrent thrombotic events for patients with MPNs treated with VKAs varies across the literature, from 8.2% in the large multicenter study by De Stefano et al 12 , 19 to 61.5% in the smaller‐scale study (comparable to ours) by Huenerbein et al 12 , 19 Given such wide variation, it is difficult to draw definitive conclusions.…”

“…The size of the DOAC group in our study is comparable to that of the other single‐institution studies, where it ranges from 18 to 26 patients. 13 , 15 , 18 , 19 The predominant MPN subtype in these studies varied, while our cohort predominantly included patients with ET. Mutation distribution was comparable between the studies, JAK2 V617F being the most common.…”

“…Three of four studies of comparable size report no recurrent events. 13 , 18 , 19 Ianotto et al 15 report one thrombotic event, CVA, but the patient’s history of AF has not been specified even though such patients were included in the study. A multicenter study evaluating the efficacy of DOACs for primary prevention of thrombosis in AF and for secondary prophylaxis in venous thromboembolism demonstrated that the rate of thrombotic events in patients with AF is lower than the rate of those treated for secondary thrombosis prophylaxis, 1.5% versus 4.5% patients per year.…”

Pulmonary Embolism and Splenic Infarction Caused by Polycythemia Vera

“…[14] For patients with existing pulmonary embolism, anticoagulants should be given in time, and studies have shown that direct oral anticoagulants (DOAC) are better than vitamin K antagonists in preventing the recurrence of thrombosis in patients with PV without increasing risks of bleeding. [15] In conclusion, pulmonary embolism and splenic infarction are less common in patients with PV. However, patients with PV should be considered the possibility of embolism, we should give early interventions to minimize or delay the harm caused by disease complications.…”