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. 2021 Nov 5;11(11):176.
doi: 10.1038/s41408-021-00566-5.

Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients

Joan How  1 , Charlotte Story  2 , Siyang Ren  3 , Donna Neuberg  3 , Rachel P Rosovsky  4 , Gabriela S Hobbs  5 , Jean M Connors  6
Affiliations

Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients

Joan How et al. Blood Cancer J. .

Abstract

Myeloproliferative neoplasms (MPNs) are characterized by an increased risk of thrombosis and bleeding. Vitamin K antagonists (VKAs) are the historic anticoagulant recommended for use in MPNs. Direct oral anticoagulants (DOACs) are being increasingly used in general and cancer populations. However, DOAC safety and efficacy in MPN patients remains unclear. We characterized real-world practice patterns of DOAC use in MPN patients and evaluated thrombosis and bleeding risk. We conducted a retrospective cohort study of 133 MPN patients prescribed DOACs for venous thromboembolism (VTE), atrial fibrillation, or arterial thromboembolism (ATE). Practice patterns including duration of anticoagulation, dosing, and concomitant use of antiplatelet/cytoreductive agents, were heterogeneous among MPN patients. The 1-year cumulative incidence of thrombosis and bleeding on DOAC was 5.5% (1.5-9.5%) and 12.3% (6.4-18.2%) respectively. In comparison, reported bleeding rates in MPN patients on DOAC and VKAs are 1-3%. On multivariable analysis, prior history of thrombosis, use of dabigatran or edoxaban, and younger age were significantly associated with a higher risk of recurrent thrombosis, while leukocytosis was associated with a higher risk of bleeding on DOAC. The higher-than-expected bleeding rate found in our study indicates the continued need for rigorous evaluation of DOACs in this population.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Cumulative incidence of thrombosis on DOAC in all MPN patients (left) and by indication (right).
A total of 12 thrombotic events occurred in 133 patients, including 6 thrombotic events in 46 patients on DOAC for atrial fibrillation (black), and 5 thrombotic events in 75 patients on DOAC for VTE (red).
Fig. 2
Fig. 2. Cumulative incidence of bleeding on DOAC in all MPN patients (left) and by indication (right).
A total of 28 bleeding events occurred in 133 patients, including 13 bleeding events in 46 patients on DOAC for atrial fibrillation (black), and 15 bleeding events in 75 patients on DOAC for VTE (red).
See this image and copyright information in PMC

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