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CHRONIC MYELOPROLIFERATIVE NEOPLASMS

Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients

Leukemia volume 35, pages 2989–2993 (2021)Cite this article

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In the Philadelphia-negative myeloproliferative neoplasms (MPN), the major burden of disease is the elevated risk of thrombosis [1]. Moreover, MPN patients are concomitantly prone to bleeding [1], making antithrombotic therapy challenging. Regarding atrial fibrillation (AF), very scarce data are available about treatment outcomes with vitamin-K antagonists (VKAs) or direct oral anticoagulants (DOACs) [2, 3]. On the other hand, VKAs partially prevent recurrent venous thromboembolism (VTE), and the incidence of either recurrent thrombosis and major bleeding is still unacceptable high [4].

DOACs emerged as a treatment of choice for secondary prevention of VTE and thrombosis prophylaxis in AF in the general population, and may be an attractive alternative to VKAs in MPN. However, evidence of their efficacy and safety in MPN is very limited and based on few retrospective observational studies [3, 5,6,7], and on scattered information from controlled trials of DOACs versus VKAs. On the other hand, randomized clinical trials comparing DOACs to VKAs are hardly feasible in MPN, given their rarity and low interest by the pharmaceutical companies. Nonetheless, DOACs are increasingly being used in the clinical practice of patients with MPN. Therefore, we considered useful to verify whether there were indications of suspected excesses of risk or decreased efficacy in the real-world practice in MPN.

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Fig. 1: Cumulative incidence of thrombosis and bleeding.

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Acknowledgements

MPN-DOACs is sponsored by FROM—Fondazione per la Ricerca Ospedale di Bergamo and endorsed by the AIRC—Gruppo Italiano Malattie Mieloproliferative (AGIMM) with the program number #21267, progetto Mynerva.

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Author notes

  1. These authors contributed equally: Tiziano Barbui, Valerio De Stefano

Authors and Affiliations

  1. FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy

    Tiziano Barbui & Alessandra Carobbio

  2. Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy

    Valerio De Stefano & Silvia Betti

  3. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

    Alessandra Iurlo & Daniele Cattaneo

  4. Hospital Clinic, Barcelona - GEMFIN, Barcelona, Spain

    Alberto Alvarez-Larran & Eduardo Arellano-Rodrigo

  5. Hospital de Burgos - GEMFIN, Burgos, Spain

    Beatriz Cuevas

  6. Hospital Morales Messeguer, Murcia - GEMFIN, Murcia, Spain

    Francisca Ferrer Marín

  7. CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Firenze, Italy

    Alessandro M. Vannucchi & Lara Mannelli

  8. Institute of Hematology “L. & A. Seragnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Francesca Palandri & Nicola Vianelli

  9. Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Claire Harrison & Andrew Doyle

  10. Princess Margaret Cancer Centre, Toronto, ON, Canada

    Hassan Sibai & Vikas Gupta

  11. Johannes Wesling Medical Center, University of Bochum, Bochum, Germany

    Martin Griesshammer & Kai Wille

  12. Department of Medicine, Section of Hematology, University of Verona, Verona, Italy

    Massimiliano Bonifacio

  13. Hematology Division and Bone Marrow Unit, San Gerardo Hospital, ASST Monza, Monza, Italy

    Elena M. Elli

  14. Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia, Italy

    Chiara Trotti

  15. Faculty of Medicine, Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University, Aachen, Germany

    Steffen Koschmieder

  16. Ospedale San Bortolo, Vicenza, Italy

    Giuseppe Carli

  17. Hematology, AOU Città della Salute e della Scienza di Torino, Turin, Italy

    Giulia Benevolo

  18. Service d’Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France

    Jean-Christophe Ianotto

  19. Albert Einstein Montefiore Medical Center, New York, NY, USA

    Swati Goel

  20. ASST Papa Giovanni XXIII, Bergamo, Italy

    Anna Falanga

  21. School of Medicine, University of Milan Bicocca, Monza, Italy

    Anna Falanga

  22. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Douglas Tremblay & John Mascarenhas

Authors
  1. Tiziano Barbui
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  2. Valerio De Stefano
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  3. Alessandra Carobbio
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  10. Claire Harrison
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  31. John Mascarenhas
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Contributions

TB designed the study, interpreted the data, and wrote the paper. VDS. interpreted the data and wrote the paper. AC accessed and verified the data and performed the statistical analysis. JM and AMV critically revised the paper. AI, AA-L, BC, FFM, AMV, FP, CH, HS, MG, MB, EME, CT, SK, GC, GB, J-CI, SG, AF, SB, DC, EA-R, LM, NV, AD, VG, KW, DT collected patient’s data of the study. All authors discussed the results and implications and commented on the manuscript, giving the final approval of the version to be published.

Corresponding author

Correspondence to Tiziano Barbui.

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Barbui, T., De Stefano, V., Carobbio, A. et al. Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients. Leukemia 35, 2989–2993 (2021). https://doi.org/10.1038/s41375-021-01279-1

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