DOACs up bleeding risk in patients with myeloproliferative neoplasms

Treating myeloproliferative neoplasm (MPN) patients with direct oral anticoagulants (DOACs) may induce higher risks of bleeding events, with no particular spikes in thrombosis rates, a recent study has found.

Researchers retrospectively assessed 133 MPN patients (median age 71 years, 56.4 percent women) who had been prescribed DOACs for venous thromboembolism (VTE), atrial fibrillation, or arterial thromboembolism (ATE). Outcomes included the incidence of bleeding and thrombosis, as well as real-world practice patterns, such as duration of use, dosing, and concomitant use with other agents.

The analysis revealed that anticoagulation ran for a median duration of 37.0 months in all patients and did not significantly differ according to indication. Thirteen patients had DOAC dose reductions after a median of 21 months. Concomitant medications included aspirin, which was continued in 50 percent of participants, and cytoreductive therapy, which was initiated in 81 percent.

Twenty-nine bleeding events occurred, including in one patient who was not taking DOACs at the time of the event. Of the 28 potentially treatment-related bleeds, six were major, four of which led to patient death. The 1-year cumulative incidence rate of bleeding was 12.3 percent and did not differ according to DOAC indication.

Over the same follow-up, 16 thrombosis events occurred, yielding a 1-year cumulative incidence rate of 5.5 percent.

Risk factors for thrombosis included a prior history of thrombosis and the use of dabigatran and edoxaban, while the only independent predictor of bleeding was elevated white blood cell counts.