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Thromb Haemost 2025; 125(04): 379-384
DOI: 10.1055/a-2379-7288
Stroke, Systemic or Venous Thromboembolism

The Efficacy and Safety of DOACs in Inherited Antithrombin Deficiency: A Cohort Study from a Tertiary Referral Center

Caroline Dix 
1   Haemophilia and Thrombosis Centre, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
,
Andrew J. Doyle 
1   Haemophilia and Thrombosis Centre, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
,
Karen Breen
1   Haemophilia and Thrombosis Centre, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
,
Beverley J. Hunt
1   Haemophilia and Thrombosis Centre, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Abstract

Background

Individuals with inherited antithrombin deficiency (IATD) have a high risk of venous thromboembolism (VTE). Most VTEs are managed with direct oral anticoagulants (DOACs), but the utility of DOACs in antithrombin deficiency (ATD) is unreported.

Materials and Methods

Patients with IATD treated with DOAC were identified from our institutions' IATD registry. We assessed patients' characteristics, ATD type, and initial VTE characteristics, thrombosis recurrence and bleeding rates.

Results

Thirty-three patients received DOACs for 73 (38.5–111.5) months (median (interquartile range)). Prior to taking DOACs, 12 (36%) patients had VTE recurrence: these occurred after anticoagulation was ceased (4), nonadherence to VKA prior to DOAC use (3), or during heparin use in pregnancy (5). There were no VTE recurrences on standard-dose DOAC, except in a noncompliant patient receiving dabigatran. There was one recurrence with compliant DOAC use—a patient receiving rivaroxaban 10 mg. Six (18%) patients experienced clinically relevant bleeding, which was predominantly menorrhagia (5/6). One major bleeding event, intracranial hemorrhage, occurred in a patient receiving full-dose rivaroxaban who had refractory hypertension (0.5 events/100 patient-years). In this cohort, compliant DOAC users had an overall VTE recurrence rate of 0.5/100 patient-years, whereas with low-dose DOACs the event rate was 3.5/100 patient-years.

Conclusion

Standard-dose DOACs appear efficacious and relatively safe in IATD.

Keywords

venous thromboembolism - antithrombin deficiency - anticoagulation - direct oral anticoagulants

Authors' Contribution

B.J.H. and A.J.D. conceived the research, C.D. collected and analyzed data; C.D., A.J.D., K.B., and B.J.H wrote and reviewed the paper.




Publikationsverlauf

Eingereicht: 12. April 2024

Angenommen: 04. August 2024

Accepted Manuscript online:
05. August 2024

Artikel online veröffentlicht:
21. August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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