Current evidence on the use of direct oral anticoagulants in patients with myeloproliferative neoplasm: a systematic review

ABSTRACT

Introduction

Thromboembolic events in myeloproliferative neoplasms (MPNs) are one of the most important causes of mortality and morbidity, in which vitamin K antagonists (VKAs) have been used mostly. Recently, direct oral anticoagulants (DOACs) are used in venous thromboembolism (VTE) and cancer-associated thrombosis (CAT). With the adoption of data from CAT and VTE, the usage of DOACs in MPNs is increasing.

Areas covered

In this paper, we performed a systematic review to the current literature regarding the usage of DOACs in MPNs. Eleven studies involving 944 patients were included. The reasons for initiating DOACs were secondary prophylaxis for thrombosis (arterial or venous) and atrial fibrillation (AF) in 562 and 382 patients, respectively. A total of 84 (8.9%) recurrent thrombotic (arterial or venous) events recorded. Forty-six (8.1%) events occurred in the thrombosis group (arterial or venous) and 38 (9.9%) events occurred in patients with AF.

Expert opinion

Ease of management and patient comfort should be regarded as benefits of DOACs compared to VKAs. However, it would be appropriate to bring an individualized approach until we obtain high-quality data with prospectively designed studies involving more patients and longer follow-up time concerning the use of DOACs in patients with MPNs.

KEYWORDS:

• Anticoagulation therapy
• bleeding
• direct oral anticoagulants
• myeloproliferative neoplasm
• MPN
• thrombosis

Article highlights

• There are efforts to improve thrombotic risk in MPN patients despite the proper application of therapeutics advised by the current recommendations.

• The literature review revealed 11 articles reporting clinical data with DOACs in MPN.

• Although most data for the usage of DOACs in MPN comes from retrospective studies, results are generally promising.

• It is necessary to conduct new research to evaluate the effectiveness and bleeding risk for DOACs in MPN.

Declaration of Interest

AE Eşkazan has received advisory board and speaker bureau honoraria from Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.