PB0928 - Direct Oral Anticoagulants for Treatment of Venous Thromboembolism in Patients with Hematological Malignancies

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

RR

Renana Robinson

Fellow
Institute of Hematology, Davidoff Cancer Centre, Rabin Medical Centre
Kfar Saba, HaMerkaz, Israel
Galia Spectre, MD PhD

Head of Thrombosis and Haemosasis Unit, Department of Hematology
Institute of Hematology, Rabin Medical Center, Petah Tikva
Petah Tikva, HaMerkaz, Israel
ML

Michael Lishner

Head
Meir Research Institute, Meir Medical Center
Ra'anana, HaMerkaz, Israel
OS

Ofek Sharabi

Medical student
Sackler School of Medicine, Tel Aviv University
Petah Tikva, HaMerkaz, Israel
ER

Eyal Robinson

Fellow
Intensive Care Unit, Rabin Medical Centre
Kfar Saba, HaMerkaz, Israel
OH

Orly Hamburger Avnery

Hematologist
Institute of Hematology, Meir Medical Center
Kfar Saba, HaMerkaz, Israel
AG

Anat Gafter-Gvili

Head
internal medicine A, Rabin Medical Centre
Hod Hasharon, HaMerkaz, Israel
PR

Pia Raanani

Head division of Hematology
Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel.
Petah Tikva, HaMerkaz, Israel

Presenting Author(s)

Avi Leader, MD

Hematologist
Institute of Hematology, Rabin Medical Center, Petah Tikva
Petah Tikva, HaMerkaz, Israel

Background: Data is needed on direct oral anticoagulants (DOACs) for treatment of venous thromboembolism (VTE) in hematological malignancies (HM). Retrospective studies to date lacked a control group and included patients with atrial fibrillation and/or VTE, but not VTE alone.

Aims: Assess incidence of VTE recurrence and bleeding in HM patients treated with low molecular weight heparin (LMWH) or DOACs for acute VTE.

Methods: Retrospective cohort study including patients with active HM and newly-diagnosed VTE treated at Rabin or Meir Medical Centers (1/2015-7/2021). Patients indexed on the first day of anticoagulation for VTE and followed for 12 months. The primary outcome was a composite of recurrent VTE, clot progression, major bleeding or clinically relevant non-major bleeding (CRNMB). 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.

Results: 143 HM patients treated with LMWH (96) or DOACs (47) for acute VTE were included. Table 1 shows patient characteristics. HM was lymphoma in 83 (58%). DOAC-treated patients were older, had more pulmonary embolism and less splanchnic vein thrombosis.
The 12-month cumulative incidence of the primary outcome (Figure 1) 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]). There were 13 (13.5%) CRNMB cases in the LMWH group and 5 (10.6%) in the DOAC group (HR 1.44 [0.52-3.98]).

Conclusion(s): This study generates the hypothesis that DOACs may be a safe and effective alternative to LMWH for VTE in patients with lymphoma or plasma cell dyscrasia. Larger prospective studies are needed to confirm these findings.