Background: DOACs are effective in preventing and treating VTE. However, in clinical practice, treatment failure (recurrent VTE, post-thrombotic syndrome) and unexpected changes in coagulation tests occur.
Aims: We present rare complications of DOAC treatment (rivaroxaban, dabigatran, apixaban) in adequately anticoagulated patients: recurrent VTE, post-thrombotic syndrome, thrombocytopenia, coagulation factor deficiency, FVIII inhibitor.
Methods: 18 patients with proximal lower limb thrombosis, pulmonary embolism, adequately anticoagulated; laboratory tests: platelets, PT, APTT, antithrombin, coagulation factors, FVIII inhibitor, endogenous thrombin potential, DOAC concentration.
Results: Recurrence of VTE was observed in two patients, post-thrombotic changes were observed in one patient after 6 months of anticoagulant treatment, and recurrent VTE was observed 4 to 32 weeks after cessation of treatment in three patients. In 9 patients we found out a false coagulation factor deficiency, a false FVIII inhibitor, during DOAC treatment, and in three patients, we found DOAC-induced thrombocytopenia.
Conclusions: Therapeutic strategies in such situations are limited. Optimal management of DOAC treatment failure is not clear and the options include the following: dose escalation, switching over to an alternative anticoagulant, adding an antiplatelet agents. In clinical practice, it is important to decide whether treatment failure is due to drug (DOAC) or underlying disease. It is important to correctly diagnose recurrence of VTE, to distinguish recurrence from the residual thrombosis, and to correctly interpret the laboratory test results.
To cite this abstract in AMA style:Hulikova M, Hulik S, Hulikova J. Rare Complications of DOAC Treatment [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/rare-complications-of-doac-treatment/. Accessed December 1, 2022.
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