Myeloproliferative neoplasms (MPNs) are characterized by an increased risk of thrombosis and bleeding. Vitamin K antagonists (VKAs) are the historic anticoagulant recommended for use in MPNs. Direct oral anticoagulants (DOACs) are being increasingly used in general and cancer populations. However, DOAC safety and efficacy in MPN patients remains unclear. We characterized real-world practice patterns of DOAC use in MPN patients and evaluated thrombosis and bleeding risk. We conducted a retrospective cohort study of 133 MPN patients prescribed DOACs for venous thromboembolism (VTE), atrial fibrillation, or arterial thromboembolism (ATE). Practice patterns including duration of anticoagulation, dosing, and concomitant use of antiplatelet/cytoreductive agents, were heterogeneous among MPN patients. The 1-year cumulative incidence of thrombosis and bleeding on DOAC was 5.5% (1.5–9.5%) and 12.3% (6.4–18.2%) respectively. In comparison, reported bleeding rates in MPN patients on DOAC and VKAs are 1–3%. On multivariable analysis, prior history of thrombosis, use of dabigatran or edoxaban, and younger age were significantly associated with a higher risk of recurrent thrombosis, while leukocytosis was associated with a higher risk of bleeding on DOAC. The higher-than-expected bleeding rate found in our study indicates the continued need for rigorous evaluation of DOACs in this population.

骨髓增生性肿瘤 (MPN) 的特征是血栓形成和出血的风险增加。维生素 K 拮抗剂 (VKA) 是历史上推荐用于 MPN 的抗凝剂。直接口服抗凝剂 (DOAC) 越来越多地用于一般人群和癌症人群。然而，DOAC 在 MPN 患者中的安全性和有效性仍不清楚。我们描述了 MPN 患者 DOAC 使用的真实世界实践模式，并评估了血栓形成和出血风险。我们对 133 名因静脉血栓栓塞 (VTE)、心房颤动或动脉血栓栓塞 (ATE) 开具 DOAC 的 MPN 患者进行了一项回顾性队列研究。MPN 患者的实践模式，包括抗凝持续时间、剂量和同时使用抗血小板/减细胞药物，存在异质性。DOAC 1 年血栓形成和出血的累积发生率分别为 5.5% (1.5-9.5%) 和 12.3% (6.4-18.2%)。相比之下，在 MPN 患者中报告的 DOAC 和 VKA 出血率为 1-3%。在多变量分析中，血栓既往史、使用达比加群或依度沙班以及年龄较小与血栓复发风险较高显着相关，而白细胞增多与 DOAC 出血风险较高相关。在我们的研究中发现的高于预期的出血率表明继续需要对这一人群中的 DOAC 进行严格评估。和年轻与血栓复发风险较高显着相关，而白细胞增多与 DOAC 出血风险较高相关。在我们的研究中发现的高于预期的出血率表明继续需要对这一人群中的 DOAC 进行严格评估。和年轻与血栓复发风险较高显着相关，而白细胞增多与 DOAC 出血风险较高相关。在我们的研究中发现的高于预期的出血率表明继续需要对这一人群中的 DOAC 进行严格评估。