PB0991 - Outcomes of Bleeding in Patients with Myeloproliferative Neoplasms Treated with Direct Oral Anticoagulants

Background: Bleeding and thrombosis represent common complications in myeloproliferative neoplasms (MPNs) and significantly contribute to morbidity and mortality. The risk of bleeding associated with direct oral anticoagulants (DOACs) in patients with MPNs remains unclear.

Aims: This study aims to investigate the incidence of bleeding complications in MPN patients, specifically those with atrial fibrillation (AF) or venous thromboembolism (VTE), who are treated with DOACs in real-world clinical practice.

Methods: We conducted a large, retrospective, nationwide cohort study using the Korean Health Insurance Review and Assessment Service database from 2010 to 2021. We focused on three clinical outcomes: intracranial hemorrhage, hospitalization due to gastrointestinal (GI) bleeding, and hospitalization due to major bleeding.

Results: We identified 371 MPN patients treated with DOACs (including dabigatran, apixaban, rivaroxaban, and edoxaban) for a concomitant diagnosis of AF (N = 231) or the occurrence of VTE (N = 140). Concomitant therapies included antiplatelet agents (34.5%) and cytoreductive drugs (56.3%), with hydroxyurea accounting for 76.1% of the cytoreductive therapies. Compared to the VTE group, the AF group was statistically significantly older (p = 0.010) and had a higher proportion of patients with elevated CHA2DS2-VASc scores (p = 0.021). In AF patients, after a median follow-up of 38.7 months (IQR: 19.8 - 56.7 months), the incidences of ICH, hospitalization for GI bleeding, and hospitalization for major bleeding were 2.2%, 3.5%, and 5.6%, respectively. In VTE patients, after a median follow-up of 37.0 months (IQR: 17.3 - 60.3 months), the incidences of ICH, hospitalization for GI bleeding, and hospitalization for major bleeding were 1.4%, 1.4%, and 2.9%, respectively.

Conclusion(s): Although the data are retrospective and have limited interpretability, the treatment of patients with MPN using DOACs appears feasible and is associated with an acceptable rate of bleeding complications.