Abstract Number: PB2161
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: The recommended anticoagulant treatment for patients with hematological malignancies is low molecular weight heparin (LMWH), considered the safest in this particular patients setting. Although direct oral anticoagulants (DOACs) have proven their efficacy and safety in patients with cancer, their use can be challenging in patients with hematological malignancies due to the peculiarity of these neoplasms: possible rapid onset of thrombocytopenia, coagulopathy and drug-drug interactions with concomitant anti-cancer therapies.
Aims: Purpose of our study was to evaluate the efficacy and safety of DOACs for venous thromboembolism (VTE) or atrial fibrillation (AF) in patients with hematological malignancies and any pharmacokinetic interferences with the concomitant anti-cancer therapy.
Methods: We retrospectively evaluated patients with hematological malignancies who received DOACs for VTE or AF until a platelet count ≥50×109/l. In case of bleeding or thrombotic complications and during concomitant anti-cancer treatment, we performed DOACs plasma levels (trough and peak).
Results: The patients evaluated were 134. The hematological malignancies are summarized in table 1 and the concomitant therapies are reported in table 2. The median follow-up was 12 months. We did not observe nor thrombotic neither major hemorrhagic adverse events. Minor bleedings occurred in 12 patients: DOACs dose was reduced in 5/12 patients due to concomitant high DOACs peak plasma levels. All these 5 patients were performing tirosine kinase inhibitor therapy: DOACs dose reduction in these patients resulted safe without any further hemorrhagic or thrombotic complications. Six patients discontinued DOACs during disease progression for a platelet count < 50x109/l after a median time of 8.4 months.
Conclusions: DOACs resulted effective and safe in patients with hematological malignancies. Anticoagulants plasma level can be helpful in suggesting an early dose adjustment to prevent hemorrhagic adverse events. Larger prospective studies are warranted to confirm the safety and efficacy of DOACs in hematological patients.
| Diagnosis | Patients (n=134) |
| Ph negative Myeloprolipherative Neoplasms | 49 |
| Non-Hodgkin Lymphoma | 26 |
| Hodgkin-Lymphoma | 3 |
| Chronic Lymphocytic Leukemia | 13 |
| Myelodisplastic Syndrome | 13 |
| Acute Leukemia | 11 |
| Multiple Myeloma | 10 |
| Chronic Myeloid Leukemia | 9 |
[1. Hematological malignancies]
| Concomitant therapy | Patients (n=134) |
| Chemotherapy and/or immunotherapy | 28 |
| Tyrosine kinase inhibitors | 23 |
| Immunomodulatory agents | 7 |
| BCL-2 inhibitor | 3 |
| Hypomethylating agents | 3 |
| Supportive care/ cytoreductive therapy | 70 |
[2. Concomitant anti-cancer therapies]
To cite this abstract in AMA style:
Serrao A, Fiori L, Santoro C, Breccia M, Baldacci E, De Luca ML, De Luca G, Barone F, Chistolini A. Direct Oral Anticoagulants in Patients with Hematological Malignancies [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-in-patients-with-hematological-malignancies/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anticoagulants-in-patients-with-hematological-malignancies/