Dr. Nagalla on the Utility of DOACs in MPN-Associated Thrombosis

Srikanth Nagalla, MD, director, Hematology Oncology Fellowship Program, Harold C. Simmons Comprehensive Cancer Center, and associate professor of medicine, UT Southwestern Medical Center, discusses the utility of direct oral anticoagulants (DOACs) in patients with a myeloproliferative neoplasm (MPN)—associated venous thromboembolism (VTE).

Historically, DOACs have been used to treat portal vein thrombosis or cerebral venous thrombosis associated with JAK2-positive or JAK2-negative MPNs, including polycythemia vera, essential thrombocytopenia, and myelofibrosis, says Nagalla.

In a retrospective analysis that was presented at the 2019 ASH Annual Meeting, 102 patients who had an MPN-associated VTE were identified, 24 of which received a DOAC. Of the 24 patients, 18 were JAK2-positive and had increased thrombogenicity, says Nagalla.

At a median follow-up of 2.2 years, findings revealed that there were no VTE recurrences in 23 patients who received a DOAC. One patient had indeterminate imaging. Additionally, there were no major bleeding episodes in this patient population.

Clinically relevant non-major bleeding occurred in 2 patients who were taking aspirin in addition to a DOAC. As such, these data suggest that patients without cardiovascular risk factors can forego daily aspirin if they are receiving a DOAC, Nagalla concludes.