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

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. H...

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Autores principales:	Joan How, Charlotte Story, Siyang Ren, Donna Neuberg, Rachel P. Rosovsky, Gabriela S. Hobbs, Jean M. Connors
Formato:	article
Lenguaje:	EN
Publicado:	Nature Publishing Group 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/1bf298661bb7441685ae80d6e5b9f931
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spelling	oai:doaj.org-article:1bf298661bb7441685ae80d6e5b9f9312021-11-08T11:17:34ZPractice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients10.1038/s41408-021-00566-52044-5385https://doaj.org/article/1bf298661bb7441685ae80d6e5b9f9312021-11-01T00:00:00Zhttps://doi.org/10.1038/s41408-021-00566-5https://doaj.org/toc/2044-5385Abstract 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.Joan HowCharlotte StorySiyang RenDonna NeubergRachel P. RosovskyGabriela S. HobbsJean M. ConnorsNature Publishing GrouparticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBlood Cancer Journal, Vol 11, Iss 11, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Joan How Charlotte Story Siyang Ren Donna Neuberg Rachel P. Rosovsky Gabriela S. Hobbs Jean M. Connors Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
description	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.
format	article
author	Joan How Charlotte Story Siyang Ren Donna Neuberg Rachel P. Rosovsky Gabriela S. Hobbs Jean M. Connors
author_facet	Joan How Charlotte Story Siyang Ren Donna Neuberg Rachel P. Rosovsky Gabriela S. Hobbs Jean M. Connors
author_sort	Joan How
title	Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
title_short	Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
title_full	Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
title_fullStr	Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
title_full_unstemmed	Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
title_sort	practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients
publisher	Nature Publishing Group
publishDate	2021
url	https://doaj.org/article/1bf298661bb7441685ae80d6e5b9f931
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Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients

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