Fedorov Kateryna, Goel Swati, Kushnir Margarita, Billett Henny H
Division of Hematology Department of Oncology Montefiore Medical Center and the Albert Einstein College of Medicine Bronx NY USA.
Res Pract Thromb Haemost. 2021 Sep 14;5(6):e12574. doi: 10.1002/rth2.12574. eCollection 2021 Aug.
Patients with myeloproliferative neoplasms (MPNs), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at an increased risk of recurrent thromboembolic events (TEs) and hemorrhagic complications. Anticoagulation with vitamin K antagonists (VKAs) had been the standard of care until the recent US Food and Drug Administration approval of direct oral anticoagulants (DOACs) for treatment of cancer-associated thrombosis. However, since patients with MPNs were underrepresented in large studies, the use of DOACs in patients with MPN-associated thrombosis remains understudied.
The primary objective of this study was to establish the incidence of recurrent TEs and hemorrhagic complications in patients with MPN-associated thrombosis treated with DOACs versus VKAs as first-line therapy.
Data from 30 patients ≥18 years old with established diagnoses of PV or ET who were treated with either DOACs or VKAs as the first-line anticoagulant for arterial and/or venous thrombosis were reviewed to determine the incidence of recurrent TEs as well as hemorrhagic complications.
Nineteen patients were treated with DOACs, and 11 were treated with VKAs. Of those on DOACs, 1 had a recurrent thrombosis, and 4 had bleeding events. Of the 11 patients treated with VKAs, 1 had a recurrent thrombotic event, and 1 had a bleeding event.
Our data did not demonstrate a significant difference in recurrent TEs or bleeding events in patients with MPN-associated thrombosis anticoagulated with either DOACs or VKAs.
骨髓增殖性肿瘤（MPN）患者，如真性红细胞增多症（PV）、原发性血小板增多症（ET）和原发性骨髓纤维化（PMF），发生复发性血栓栓塞事件（TE）和出血并发症的风险增加。在最近美国食品药品监督管理局批准直接口服抗凝剂（DOAC）用于治疗癌症相关血栓形成之前，维生素K拮抗剂（VKA）抗凝一直是标准治疗方法。然而，由于MPN患者在大型研究中的代表性不足，DOAC在MPN相关血栓形成患者中的应用仍未得到充分研究。
本研究的主要目的是确定以DOAC与VKA作为一线治疗的MPN相关血栓形成患者中复发性TE和出血并发症的发生率。
回顾了30例年龄≥18岁、已确诊PV或ET且接受DOAC或VKA作为动脉和/或静脉血栓形成一线抗凝治疗的患者的数据，以确定复发性TE以及出血并发症的发生率。
19例患者接受DOAC治疗，11例接受VKA治疗。在接受DOAC治疗的患者中，1例发生复发性血栓形成，4例发生出血事件。在接受VKA治疗的11例患者中，1例发生复发性血栓事件，1例发生出血事件。
我们的数据未显示在MPN相关血栓形成患者中，使用DOAC或VKA进行抗凝治疗的复发性TE或出血事件有显著差异。
