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Comparison of standard vs low dose of direct oral anticoagulants for the secondary prophylaxis of venous thromboembolism in patients affected by hematologic malignancies

1Hematology, Sapienza University, Rome, Italy, Rome, Lazio, Italy, 2Hematology, Sapienza University of Rome, Rome, Lazio, Italy, 3Sapienza University of Rome, Rome, Lazio, Italy, 4Hematology, University Hospital Policlinico Umberto I, Rome, Rome, Lazio, Italy

Abstract Number: PB0910

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » Cancer Associated Thrombosis

Background: Venous thromboembolism (VTE) is one serious complication in patients with hematologic malignancies due to the release of procoagulant factors by neoplastic cells, central venous catheter and chemotherapy. Considering that hematologic malignancies represent a non-transient VTE risk factor, the treatment and secondary prophylaxis of VTE are an important step in the therapeutic approach of hematologic patients. Although direct oral anticoagulants (DOACs) demonstrated their efficacy and safety in the treatment of acute phase of VTE cancer related, there are few data in the setting of the secondary prophylaxis.

Aims: The aim of our study was to evaluate the efficacy and safety of DOACs in the VTE secondary prophylaxis in hematologic patients, comparing full and low dose of DOACs.

Methods: This retrospective monocentric study collected data of patients affected by hematologic malignancies with VTE (pulmonary embolism and deep vein thrombosis of typical sites) treated with DOACs. We divided the patients in 2 groups according to DOACs dose performed after the first 6 months of VTE treatment: one group continue with standard dose and the other group shifted to apixaban 2.5 BID or rivaroxaban 10 QD.

Results: We studied 55 patients (table 1). After a median time of 6 months from a first VTE, 29 patients continued with DOAC at full dose, 26 patients shifted to DOACs at reduced dose. After a median time of 24 months (range 19-32) no thrombotic recurrences were observed in the two groups. We reported 4 minor bleeding events: 3 in the group treated with full dose and 1 in the other group. We did not report any statistically significant differences in terms of DOACs efficacy and safety between the two groups.

Conclusion(s): Our experience supports the use of DOACs also at reduced dosage in the VTE secondary prophylaxis in patients affected by hematologic malignancies.

Table 1

Patients’ characteristics.

DVT: deep vein thrombosis, PE: pulmonary embolism, NHL: non Hodgkin lymphoma, HL: Hodgkin lymphoma, MPN: myeloproliferative neoplasm, MM: multiple myeloma, MDS: myelodysplastic syndrome, CLL: chronic lymphoid leukemia, AML: acute myeloid leukemia, DOAC: direct oral anticoagulants, NA: not applicable.

To cite this abstract in AMA style:

Serrao A, Chavez Orellana M, Assanto G, Mormile R, Baldacci E, Santoro C, Chistolini A. Comparison of standard vs low dose of direct oral anticoagulants for the secondary prophylaxis of venous thromboembolism in patients affected by hematologic malignancies [abstract]. https://abstracts.isth.org/abstract/comparison-of-standard-vs-low-dose-of-direct-oral-anticoagulants-for-the-secondary-prophylaxis-of-venous-thromboembolism-in-patients-affected-by-hematologic-malignancies/. Accessed September 29, 2023.

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