A recent study in the Journal of the American Heart Association suggests that direct oral anticoagulants and heparin/vitamin K antagonists were similar for the treatment of venous thromboembolism (VTE) in patients with inherited thrombophilia.
Researchers for the study enrolled consecutive patients with acute VTE and inherited thrombophilia treated with direct oral anticoagulants (cases) or heparin/vitamin K antagonists (matched controls). Participants were matched for age, sex, ethnicity, and thrombophilia type. The primary study endpoints of interest were VTE recurrence and bleeding complications; residual vein thrombosis and post-thrombotic syndrome; and VTE recurrence after anticoagulant discontinuation. There were 255 cases of thrombophilia and 322 controls.
According to the results, the cumulative incidence of VTE recurrence during anticoagulation was. 1.09% vs. 1.83% in the control group (adjusted hazard HR=0.67; 95% CI, 0.16 to 2.77). Cumulative bleeding incidence was 10.2% in the treatment group vs. 4.97% in the controls (adjusted HR=2.24; 95% CI, 1.10 to 4.58). The researchers reported no major bleeds in the case group (vs. three in the control group), and there were no significant differences in residual vein thrombosis and post-thrombotic syndrome. Direct oral anticoagulants were associated with a significant decrease in two-year VTE recurrence risk compared with traditional anticoagulants (HR=0.61; 95% CI, 0.47 to 0.82).
“In this cohort of patients with a confirmed diagnosis of inherited thrombophilia—including most severe and rare forms—direct oral anticoagulants showed an efficacy profile comparable to that of heparin/vitamin K antagonists,” the authors wrote in their conclusion. “Additionally, direct oral anticoagulants proved safe in patients with thrombophilia, despite a significant increase in clinically relevant nonmajor menometrorrhagia.”
They went on to note the importance of anticoagulants in this patient population.
“The importance of these findings in daily clinical practice cannot be overstated as they confirm the efficacy and safety of direct oral anticoagulants for VTE treatment and recurrence prevention in patients carrying severe and mild forms of inherited thrombophilia,” they wrote.