Cancer Res Treat.  2025 Apr;57(2):612-620. 10.4143/crt.2024.738.

The Role of Direct Oral Anticoagulants in Managing Myeloproliferative Neoplasms Patients

• Lee JY
• Lee JH
• Park W
• Seo J
• Kang M
• Jung EH
• Kim SA
• Suh KJ
• Kim JW
• Kim SH
• Lee JO
• Kim JW
• Kim YJ
• Lee KW
• Kim JH
• Bang SM

• KMID: 2566877
• DOI: http://doi.org/10.4143/crt.2024.738

Abstract

Purpose
Thrombosis and bleeding significantly affect morbidity and mortality in myeloproliferative neoplasms (MPNs). The efficacy and safety of direct oral anticoagulants (DOACs) in MPN patients remain uncertain.
Materials and Methods
We conducted a large, retrospective, nationwide cohort study using the Korean Health Insurance Review and Assessment Service database from 2010 to 2021.
Results
Out of the 368 MPN patients included in the final analysis, 62.8% were treated with DOACs for atrial fibrillation (AF), and 37.2% for venous thromboembolism (VTE). The AF group was statistically older with higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65-74 years, sex category [female]) scores compared to the VTE group. Antiplatelet agents were used in 51.1% of cases, and cytoreductive drugs in 79.3%, with hydroxyurea being the most common (64.9%). The median follow-up was 22.3 months, with 1-year cumulative incidence rates of thrombosis and bleeding at 11.1% and 3.7%, respectively. Multivariate analysis identified CHA2DS2-VASc scores ≥ 3 (hazard ratio [HR], 3.48), concomitant antiplatelet use (HR, 2.57), and cytoreduction (HR, 2.20) as significant thrombosis risk factors but found no significant predictors for major bleeding.
Conclusion
Despite the limitations of retrospective data, DOAC treatment in MPN patients seems effective and has an acceptable bleeding risk.

Keyword

Myeloproliferative neoplasms; Direct oral anticoagulants; Thrombosis; Hemorrhage

Figure

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  Fig. 1. Cumulative incidence of thrombosis on direct oral anticoagulant in all myeloproliferative neoplasm patients (A), by indication (B), and by myeloproliferative neoplasm subtype (C). AF, atrial fibrillation; ET, essential thrombo cythemia; MF, primary myelofibrosis; PV, polycythemia vera; VTE, venous thromboembolism.

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  Fig. 2. Cumulative incidence of bleeding on direct oral anticoagulant in all myeloproliferative neoplasm patients (A), by indication (B), and by myeloproliferative neoplasm subtype (C). AF, atrial fibrillation; ET, essential thrombo cythemia; MF, primary myelofibrosis; PV, polycythemia vera; VTE, venous thromboembolism.

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