Background: Preexistent atrial fibrillation (AF) is not uncommon in cancer patients receiving therapy, and the risk of AF increases during the period adjacent to diagnosis and during active therapy. Managing anticoagulation in hematological malignancy patients with AF is a clinical challenge considering the risk of bleeding and thrombosis with limited data mainly concerning low molecular weight heparin.

Aims: The aim of our study was to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) in patients affected by hematologic malignancies with AF.

Methods: A single-center retrospective cohort study was performed by reviewing medical records of patients with a confirmed diagnosis of hematologic malignancy who presented a pre-existing AF or developed AF during the clinical course and treated with DOACs. Oral anticoagulation was continued until a platelet count ≥50×109/l.

Results: The characteristics of the 96 included patients are reported in table 1. DOACs therapy was performed for a median time of 19 months (range 11-107 months). During the entire follow-up no thrombotic adverse event were reported. Thirty-two patients (30.7%) required a suspension of DOACs: 14 (14.6%) for bleedings, 9 (9.3%) for toxicity or elevated creatinine levels and 7 (7.2%) for platelets < 50x109/L; 11 of them discontinued permanently: 7 for a low platelet count and 4 for renal failure. The hemorrhagic adverse events were all clinical relevant non major but did not require definitive discontinuation of DOAC therapy. Univariate analysis did not show significant association of bleeding events with any of the baseline characteristics reported.

Conclusion(s): Although the limitations of this study due to the retrospective nature and the relative low number of patients, DOACs appeared to be effective and safe for the treatment of AF in patients with hematologic malignancies since the hemorrhagic adverse events did not represent a cause of DOACs definitive discontinuation.

Table 1

Patients’ characteristics.

NHL: non Hodgkin lymphoma, HL: Hodgkin lymphoma, MPN: myeloproliferative neoplasm, MDS: myelodysplastic syndrome, CLL: chronic lymphoid leukemia, AML: acute myeloid leukemia, ALL: acute lymphoblastic leukemia, DOAC: direct oral anticoagulants, TKI: tyrosine kinase inhibitor.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-safety-and-efficacy-of-direct-oral-anticoagulants-for-atrial-fibrillation-in-patients-affected-by-hematologic-malignancies-a-single-center-experience/