Abstract Number: PB2484
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Direct oral anticoagulants (DOACs) are currently used in the acute and long-term treatment of venous thromboembolism (VTE). Because of their distinctive advantages, international guidelines recommend the use of DOACs over warfarin in patients without active cancer. However, the role of DOACs in the treatment of thrombophilia-associated VTE remains controversial.
Aims: To compare the efficacy and safety of DOACs vs. warfarin in thrombophilia patients using the following endpoints:
(1) VTE recurrence rates,
(2) residual symptoms at 12 months of index VTE, and
(3) bleeding rates.
Methods: A retrospective study of thrombophilia patients who were started on anticoagulation, either DOAC or warfarin, by the hematology consult service at Emory University Hospitals, for the treatment of VTE in 2015.
Results: We investigated 49 thrombophilia patients. Average follow up duration was 10.2 months (range, 1-18 months). 20 (40.8%) patients were treated with DOACs, while 29 (59.2%) received warfarin. In the DOAC group, four patients (25%) were switched from warfarin to DOAC. Table 1 illustrates the distribution of patient characteristics. Table 2 illustrates the distribution of different thrombophilia. A total of four patients experienced VTE recurrence (three patients in the DOAC group, and one patient in the warfarin group, p=0.179). Five patients (25%) in the DOAC group and five patients (17.2%) in the warfarin group complained of residual symptoms at 12 months of index VTE, p=0.32. Bleeding events occurred in four patients (20%) in DOAC group and four patients (13.8%) in warfarin group, p=0.42. Of these, five had gingival bleeding and three experienced gastrointestinal bleeding.
Conclusions: Rates of VTE recurrence and bleeding events were similar in DOACs and warfarin groups. DOACs may be a safe treatment option in thrombophilia patients. Further research is encouraged to explore whether these findings apply to specific patient subgroups such as high-risk Antiphospholipid syndrome and uncommon thrombophilia.
| Characteristic | DOAC (N=20) | Warfarin (N=29) |
| Age at index venous thromboembolism, y (Mean, (SD)) | 42 (16) | 46 (18) |
| Body mass index (Mean (SD)) | 28.27 (5.35) | 30.33 (5.88) |
| Male, n (%) | 11 (55) | 18 (62.07) |
| Caucasian, n (%) | 13 (65) | 15 (51.72) |
| African American, n (%) | 4 (20) | 9 (31.03) |
| Congestive heart failure, n (%) | 2 (10) | 0 (0) |
| Inflammatory bowel disease, n (%) | 1 (5) | 3 (10.34) |
| Cancer, n (%) | 0 (0) | 2 (6.90) |
| History of venous thromboembolism, n (%) | 10 (50) | 11 (37.93) |
[Table 1: Distribution of patient characteristics]
| Thrombophilia, n (%) | DOAC (N=20) | Warfarin (N=29) |
| Antiphospholipid syndrome | 2 (10) | 7 (24.14) |
| Heterozygous Factor V Leiden | 7 (35) | 5 (17.24) |
| Homozygous Factor V Leiden | 1 (5) | 0 (0) |
| Heterozygus Prothrombin gene mutation | 2 (10) | 3 (10.34) |
| Homozygous Prothrombin gene mutation | 0 (0) | 1 (3.45) |
| Protein C deficiency | 3 (15) | 1 (3.45) |
| Protein S deficiency | 2 (10) | 1 (3.45) |
| Antithrombin deficiency | 1 (5) | 3 (10.34) |
| Combined defects | 1 (5) | 6 (20.69) |
[Table 2: Distribution of different thrombophilia]
To cite this abstract in AMA style:
Basaria S, Elsebaie M, Li J, Gaddh M. Direct Oral Anticoagulants vs. Warfarin for the Treatment of Venous Thromboembolism in Patients with Thrombophilia. A Single Center Experience [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-vs-warfarin-for-the-treatment-of-venous-thromboembolism-in-patients-with-thrombophilia-a-single-center-experience/. Accessed September 22, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anticoagulants-vs-warfarin-for-the-treatment-of-venous-thromboembolism-in-patients-with-thrombophilia-a-single-center-experience/