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Management of DOAC-related bleeding in cancer patients: a single center-case series

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Abstract

Venous thromboembolism (VTE) and stroke carry significant mortality and morbidity in cancer patients. Direct oral anticoagulants (DOACs) have been demonstrated to be effective for the treatment of VTE and prevention of stroke in atrial fibrillation (AF). Bleeding rates are variable and are based on the cancer type and the patient’s specific risk factors. There are approved specific antidotes for DOAC-associated bleeding. Other strategies are available for bleeding reversal, including the use of prothrombin complex concentrate (PCC). No randomized studies have compared head-to-head the efficacy and safety of reversal agents. We aim to examine the safety and effectiveness of hemostatic agents in cancer patients with DOAC-related major bleeding. A retrospective chart review study of patients at MD Anderson Cancer Center with DOAC-related major bleeding between 2014 and 2019. Bleeding severity and clinical hemostasis were described based on ISTH guidelines and the Sarode criteria, respectively. The rates of thrombotic complications and mortality at 30-day from the index bleeding event were described. We identified 23 patients with DOAC-related major bleeding; 14 patients received PCC and 9 patients received andexanet alfa. The most common sites of bleeding were the gastrointestinal tract and intracranial. Effective hemostasis and 30-day mortality were similar to reported results from other reports of outcomes of reversal agents for DOAC related-bleeding in non-cancer patients. One patient in each treatment group experienced a thrombotic event. Further larger scale studies are needed to confirm our findings in cancer patients.

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The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

Katy Toale, PharmD, BCPS; for her review and comments on the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. The University of Texas Long School of Medicine, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Sophia Lee

  2. The Center for Cancer and Blood Disorders, 800 West Magnolia Avenue, Fort Worth, TX, 76104, USA

    Jeremy A. Ross

  3. The University of Texas MD Anderson Cancer Center, Pharmacy Clinical Programs, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Ali Zalpour

  4. Sarah Cannon Research Institute at HealthOne, Denver, USA

    Jason T. Henry

  5. The University of Texas MD Anderson Cancer Center, Section of Benign Hematology, 1515 Holcombe Blvd. Unit 1464, Houston, TX, 77030, USA

    Cristhiam M. Rojas Hernandez

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  1. Sophia Lee
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  3. Ali Zalpour
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Contributions

JAR, JTH and CMRH conceived the study. JAR, SL, CMRH collected and analyzed the data. SL, JAR, AZ, JTH, CMRH contributed to the writing of the manuscript.

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Correspondence to Cristhiam M. Rojas Hernandez.

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Lee, S., Ross, J.A., Zalpour, A. et al. Management of DOAC-related bleeding in cancer patients: a single center-case series. J Thromb Thrombolysis 57, 677–682 (2024). https://doi.org/10.1007/s11239-024-02962-7

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  • DOI: https://doi.org/10.1007/s11239-024-02962-7

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