PB0508 - Direct oral anticoagulants for the treatment of venous thromboembolism in patients with β-thalassemia: a multicenter analysis from the Extension-Myocardial Iron Overload in Thalassemia Network

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Simona Raso, MD,PhD (she/her/hers)

MD, PhD
Department of Hematology and Rare Diseases, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Palermo, Sicilia, Italy

Co-Author(s)

AM

Antonella Meloni

PhD
Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
Pisa, Emilia-Romagna, Italy
AS

Anna Spasiano

MD
Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso. Azienda Ospeda-liera di Rilievo Nazionale "A. Cardarelli"
Napoli, Campania, Italy
AS

Alessandra Salvo

MD
Unità Operativa Semplice Talassemia. Presidio Ospedaliero “Umberto I”
Siracusa, Sicilia, Italy
MR

Maria Grazia Roberti

MD
Servizio Trasfusionale. Azienda Ospedaliero-Universitaria OO.RR. Foggia
Foggia, Puglia, Italy
Vc

Valerio cecinati

MD
Struttura Semplice di Microcitemia. Ospedale “SS. Annunziata” ASL Taranto
Taranto, Puglia, Italy
AC

Alessandra Ciancio

MD
Unità Operativa Ematologia – Day Hospital di Talassemia, Ospedale “Madonna delle Grazie”, Matera, Italy.
Matera, Basilicata, Italy
AA

Amalia Acquafredda

MD
Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale “Di Venere”, Bari, Italy
Bari, Puglia, Italy
IF

Ilaria Fotzi

MD
Centro Talassemie ed Emoglobinopatie, Ospedale “Meyer”, Firenze, Italy
Firenza, Emilia-Romagna, Italy
RR

Rosa Maria Rosso

MD
Unità Operativa Talassemie ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Policlinico “Vittorio Emanuele”, Catania, Italy.
Catania, Sicilia, Italy
MS

Marilnea Serra

MD
Day Hospital di Talassemia, Ospedale “V. Fazzi”, Lecce, Italy.
Lecce, Puglia, Italy
CB

Costanza Bosi

MD
U. O. Ematologia e CTMO, Ospedale “G. Da Saliceto”, Piacenza, Italy
Piacenza, Emilia-Romagna, Italy

Presenting Author(s)

Mariasanta Napolitano, 310885

Associate Professor of hematology
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
Palerno, Sicilia, Italy

Co-Author(s)

VS

Vincenzo Sucato

MD, PhD
Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
Palermo, Sicilia, Italy
AG

Antonino Giangreco

MD
Department of Hematology and Rare Diseases, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Palermo, Sicilia, Italy
RD

Rosario Di Maggio

MD
Department of Hematology and Rare Diseases, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Palermo, Sicilia, Italy
AM

Aurelio Maggio

MD
Department of Hematology and Rare Diseases, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Palermo, Sicilia, Italy
AV

Angela Vitrano

Data manager
Department of Hematology and Rare Diseases, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
Palermo, Sicilia, Italy
FC

Filippo Cademartiri

Prof, PhD, MD
Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
Firenze, Emilia-Romagna, Italy

Background: Patients (PTs) with β-thalassemia (β-T) are at high risk of thrombosis due several factors including iron overload, splenectomy and chronic hemolysis. The increased thrombotic risk requires often the administration of antiplatelet and/or anticoagulant agents as treatment or prophylaxis of venous thromboembolism (VTE) and non-valvular atrial fibrillation (NVAF). Despite this, there is scarce specific evidence guiding the choice of anticoagulants in PTs with BT and there is limited experience regarding the use of direct oral anticoagulants (DOACs) which may deteriorate liver function, often already impaired for secondary hemosiderosis.

Aims: The primary objective of this study is to evaluate the employment of DOACs for VTE and NVAF treatment among PTs with βT.

Methods: We herein have performed a multicenter retrospective analysis of PTs with β-T experiencing VTE or NVAF, enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) Network study and actively treated with DOACs.

Results: Fifty-two PTs were evaluated (Table 1). Thirty out of 52 PTs started DOACs as frontline anticoagulant treatment and 22 PTs were shifted from vitamin k antagonist (VKA) therapy. Apixaban and rivaroxabann were the most frequently adopted DOACs. The median time of treatment was 49.5 months (IQR,31.5-72), during follow-up 3 PTs developed superficial vein thrombosis (SVT) and 1 intestinal ischemia, major bleeding were not reported also in those subjects under concomitant antiplatelet drugs. VTE recurrences under DOACs were treated with LMWH for a mean of 4 weeks, DOACs resulted well tolerated and they were not discontinued or dose-reduced in any subject.

Conclusion(s): We here report the first available comprehensive evaluation of DOACs in BT. However, in our experience there were no adverse events reported and no need of dose modification. Anticoagulant therapy with DOACs in PTs with βT is well tolerated, apparently safe, without recurrences of major thrombotic events and significant bleeding complications.