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Direct oral anticoagulants in patients with venous thromboembolism and hematological malignancies

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Abstract

Data are needed on direct oral anticoagulants (DOACs) for the treatment of venous thromboembolism (VTE) in hematological malignancies (HM). Retrospective studies to date lacked a control group and did not focus on patients with VTE. Out aim was to assess the incidence of VTE recurrence and bleeding in HM patients treated with low molecular weight heparin (LMWH) or DOACs for acute VTE. This is a retrospective cohort study including patients with active HM and newly-diagnosed VTE, indexed on the first day of anticoagulation and followed for 12 months. The outcome was a composite of recurrent VTE, major bleeding or clinically relevant non-major bleeding. Cumulative incidence [95% confidence interval (CI)] was calculated for each anticoagulation group (LMWH, DOAC) and hazard ratios (HR) were calculated using cox-proportional hazards model, with death as a competing risk. 143 HM patients treated with LMWH (96) or DOACs (47) for acute VTE were included. The most common HM types were lymphoma in 83 (58%) and plasma cell dyscrasia in 32 (22.3%). The 12-month cumulative incidence of the composite outcome was 24.2% (95% CI 15.9–33.5%; n = 22) in the LMWH group and 18.5% (8.5–31.5%; n = 8) in the DOAC group (HR 1.51 [0.695–3.297]). Two recurrent VTE occurred (both in the DOAC group while off-treatment). Nine (9.4%) LMWH-treated patients had major bleeding compared to 1 (2.1%) DOAC-treated patient (HR 4.85 [0.64–36.56]). This study generates the hypothesis that DOACs may be a safe and effective alternative to LMWH for VTE in patients with HM types represented in the study.

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Data availability

All data analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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Acknowledgements

The authors thank Tzippy Shochat for her help in performing the statistical analysis.

Author information

Authors and Affiliations

  1. Institute of Hematology, Davidoff Cancer Centre, Rabin Medical Centre, Petah Tikva, Israel

    Renana Robinson, Galia Spectre, Anat Gafter-Gvili, Pia Raanani & Avi Leader

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Renana Robinson, Galia Spectre, Michael Lishner, Ofek Sharabi, Anat Gafter-Gvili, Pia Raanani & Avi Leader

  3. Institute of Hematology, Meir Medical Center, Kfar Saba, Israel

    Michael Lishner & Orly Hamburger Avnery

  4. Research Institute, Meir Medical Center, Kfar Saba, Israel

    Michael Lishner

  5. Intensive Care Unit, Rabin Medical Centre, Petah Tikva, Israel

    Eyal Robinson

  6. Internal Medicine A, Rabin Medical Centre, Petah Tikva, Israel

    Anat Gafter-Gvili

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  1. Renana Robinson
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Contributions

Contribution: RR and AL participated in all aspects of the study and authored the manuscript. OS retrieved patient data, interpreted data, reviewed drafts and approved the final draft of the manuscript. GS, ML, ER, OHA, AGG and PR interpreted data, reviewed drafts and approved the final draft of the manuscript.

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Correspondence to Renana Robinson.

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Competing interests

Galia Spectre is consultant to Pfizer, Bayer, Boehringer Ingelheim, Sanofi, Novartis and Medison; is on the scientific advisory board of Pfizer, Bayer, Sanofi, Medison and Neopharm; and is a stockholder in NA. Anat Gafter-Gvili is consultant to Bayer, Pfizer and Sanofi and is on the scientific advisory board of Pfizer, Bayer, Sanofi and BI. Pia Raanani is consultant to Pfizer, Novartis and BMS; is on the advisory board of Pfizer; is on the speaker’s bureau of Pfizer and Janssen; and has received research support from Pfizer and Novartis. Avi Leader is on the advisory board of Pfizer, Bayer, Sanofi, Leo Pharma and Novartis. R. Robinson, M. Lishner, O. Sharabi, E. Robinson, and O. Hamburger Avnery declare they have no financial or non-financial interests. 

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Robinson, R., Spectre, G., Lishner, M. et al. Direct oral anticoagulants in patients with venous thromboembolism and hematological malignancies. J Thromb Thrombolysis 55, 729–736 (2023). https://doi.org/10.1007/s11239-023-02791-0

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