Warfarin or Direct Oral Anticoagulants for Thrombosis in Myeloproliferative Neoplasms?

Anticoagulation with vitamin K antagonists (VKAs) such as warfarin has been the standard of care for thrombosis in patients with myeloproliferative neoplasms (MPNs), until the U.S. Food and Drug Administration’s recent approval of direct oral anticoagulants (DOACs) for the treatment of cancer-associated thrombosis. However, according to authors of a study recently published in Research and Practice in Thrombosis and Haemostasis, patients with MPNs were underrepresented in large studies.

Because the use of DOACs in patients with MPN-associated thrombosis remains understudied, researchers sought to establish the incidence of recurrent thromboembolic events and hemorrhagic complications in patients with MPN-associated thrombosis treated with DOACs versus VKAs as first-line therapy.

The study included 30 adults with established diagnoses of polycythemia vera or essential thrombocythemia who were treated with either DOACs or VKAs as the first-line anticoagulant for arterial and/or venous thrombosis.

A total of 19 patients were treated with DOACs, and 11 were treated with VKAs. Among the patients who received DOACs, one had a recurrent thrombosis and four had bleeding events. Of those treated with VKAs, one had a recurrent thrombotic event and one had a bleeding event.

“Our data did not demonstrate a significant difference in recurrent TEs or bleeding events in patients with MPN-associated thrombosis anticoagulated with either DOACs or VKAs,” the authors concluded.