PB1474 - Unusual Site Thrombosis and Direct Oral Anticoagulants Treatment: A Single-Centre Study

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

AT

Ambra Taglietti

Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
roma, Lazio, Italy

Co-Author(s)

AS

Alessandra Serrao

Hematologist, Medical Doctor
(2) Haematology and Stem Cell Transplant Unit, A. O. San Camillo Forlanini (L.R.), Rome, Italy.
Rome, Lazio, Italy
AG

Angelo Genoese

Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy
CS

Cristina Santoro

Hematologist, Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
roma, Lazio, Italy
AL

Alessandro Laganà

Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy
CM

Chiara Masucci

Hematologist, Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy
SO

Sandra Olivieri

Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy
SL

Silvio Ligia

Hematologist, Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy

Presenting Author(s)

EB

Erminia Baldacci

Hematologist, Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
roma, Lazio, Italy

Co-Author(s)

RM

Rosaria Mormile

Biologist
(1) Hematology, Department of Translational and precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy
AC

Antonio Chistolini

Professor, Hematologist, Medical Doctor
(1) Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Rome, Lazio, Italy

Background: Direct oral anticoagulants (DOACs) deeply changed the therapeutic approach to venous thromboembolism (VTE). However, DOACs are not currently licensed for the treatment of unusual site VTE and evidence about their safety and efficacy is lacking in these settings.

Aims: We report our experience with DOAC-based treatment as well as secondary prophylaxis in patients with unusual site VTE.

Methods: In this retrospective, single-centre study, we enrolled DOAC-treated patients with unusual site VTE.

Results: 77 patients were enrolled from March 2016 to May 2023 (table 1). Unusual sites included 54 splanchnic, 16 cerebral, 4 renal, and 3 gonadal veins. Median age was 53 (13-83) and the median follow-up was 24.93 months (2.53-84.57). 64 patients had recognizable risk factors.
At the time of DOAC initiation, 73 patients were anticoagulated with either heparin or vitamin K antagonists (VKAs). 12 patients switched to low-dose secondary prophylaxis, 5 patients required renal dosage, whereas 50 started standard-dose DOACs.
During our follow-up, 6 patients stopped therapy after recanalization, whereas 30 patients switched to secondary prophylaxis due to their recurrence risk. The median time before switch was 21.63 months (2.40-44.63). A patient developed a new deep vein thrombosis 2 weeks after discontinuation.
During DOAC therapy, 6 patients experienced recurrent VTE and were switched to alternative anticoagulants (3 had new antiphospholipid antibody positivity).
11 bleeding complications occurred: 4 major, 4 clinically relevant, and 3 minor. One patient permanently discontinued. No other relevant complications were observed.

Conclusion(s): We report our encouraging experience with DOACs for unusual site VTE. In our cohort, only 6 patients (7.79%) experienced recurrent VTE during DOAC therapy, whereas one patient experienced a bleed that required permanent discontinuation. Furthermore, patients that had switched to DOACs from VKAs or heparin reported improved quality of life. Despite the scarce evidence, we believe that DOACs should be considered a valid treatment for unusual site VTE.