Premium
Direct oral anticoagulant medications in calciphylaxis
Author(s) -
King Brian J.,
elAzhary Rokea A.,
McEvoy Marian T.,
Shields Raymond C.,
McBane Robert D.,
McCarthy James T.,
Davis Mark D. P.
Publication year - 2017
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.13685
Subject(s) - calciphylaxis , medicine , rivaroxaban , apixaban , warfarin , dabigatran , kidney disease , surgery , adverse effect , dialysis , medical record , phenprocoumon , disease , atrial fibrillation
Background Recent studies suggest that calciphylaxis is a thrombotic condition in which arteriolar thrombosis leads to painful skin infarcts and consequent morbidity and mortality. Paradoxically, warfarin is implicated as a risk factor for calciphylaxis. Our objective is to report the use of oral direct thrombin and factor Xa inhibitors (termed direct oral anticoagulants [DOACs]) in patients with calciphylaxis. Methods We retrospectively reviewed records of 16 patients with calciphylaxis who received concomitant administration of novel anticoagulants. Patient data, including demographics, comorbidities, other treatments, and adverse events, were abstracted from the health records. Results Eleven patients (69%) had chronic kidney disease (stage ≥3A), and eight (50%) received dialysis. Apixaban was the most frequently used agent ( n = 11 [69%]). Dabigatran ( n = 4 [25%]) and rivaroxaban ( n = 2 [13%]) were reserved for patients with mild renal impairment (stage ≤2). One clinically relevant but nonmajor bleeding event occurred. There were no major bleeding events. Nine patients (56%) were alive at last follow‐up, and five (31%) had complete resolution of their calciphylaxis (mean follow‐up, 523 days; range, 26–1884 days). Conclusion DOAC s were safe and well tolerated in patients with calciphylaxis, in this initial experience. Several patients had improvement or resolution of calciphylaxis in response to therapy that included DOAC s. The degree of renal impairment should guide DOAC choice. Randomized trials are required to determine treatment efficacy.