PB2441 DIRECT ORAL ANTICOAGULATION IN PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS: A SINGLE‐CENTER REAL‐LIFE EXPERIENCE

Background: The risk of developing a venous thromboembolic event (VTE) in Myeloproliferative Neoplasms (MPNs) accounts from 5 to 10‐fold the general population risk. According to recommendations of European Leukemia Net, patients affected by MPNs already diagnosed with VTE have to be considered at high risk for VTE recurrence. To date the standard treatment adopted for prevention and treatment of VTE in this setting of patients is represented by low molecular weight heparin (LMWH) and vitamin K antagonists (AVK). Recent data have demonstrated the noninferiority of direct oral anticoagulant (DOAC) drugs, when compared to LMWH, in preventing VTE recurrences in patients affected by cancer with an acceptable toxic profile. However, there are only scarce evidences on the safety and efficacy of DOACs in patients with hematological malignancies. Aims: Our aim is to collect real‐life data on the use, efficacy and safety of DOACs in patients with diagnosis of MPNs. Methods: Data from 51 patients affected by MPNs on anticoagulant therapies were collected. Of them, 27 were on treatment with AVK, 4 on LMWH and 20 on DOAC. Data from the 20 MPNs patients taking DOACs for treatment/prevention of VTE or atrial fibrillation (AF) were retrospectively collected in a specific database. Data were analyzed with descriptive statistic tools. Adverse events were graded according to the “Common Terminology Criteria – Adverse Events” (CTC‐AE) scale. Results: 14/20 (70%) of the patients on treatment with DOAC have the indication for prevention of VTE recurrences and 6/20 (30%) for AF. Of the 20 patients, 5 were taking dabigatran, 6 rivaroxaban, 3 apixaban and 4 edoxaban. Of the 14 patients on anticoagulation treatment for prevention of VTE, 2 (14.3%) patients failed prevention and showed VTE recurrence: in one case, because of drug failure a second line prophylaxis therapy with warfarin was started; in the second case, failure was due to inadequate cytoreduction for MPN and the DOAC was not dropped. Bleeding was registered in three cases: 2 graded as first and 1 as second grade as per CTC AE classification. Grade 2 bleeding was resolved with dose reduction of anticoagulation treatment. None of the patient was concomitantly under antiplatelet therapy. Summary/Conclusion: Real life data from a single center experience on the use of DOAC in patients with MPN suggest that also in these setting of patients DOACs are safe. More extensive data collection is needed to confirm these preliminary findings.