Abstract
Background: Venous thromboembolism (VTE) is a recognized complication of sickle cell disease (SCD), yet the optimal pharmacologic anticoagulant is unknown. Methods: A retrospective single-institution cohort study of patients with SCD complicated by first VTE from January 2009 through July 2017 was performed using ICD 9/10 codes. Data collected included the anticoagulant used, VTE recurrence, and incidence of bleeding. Results: 109 patients with VTE were identified. SCD genotypes included HbSS in 92 (84%), HbSC in 13 (12%), and HbS-β+ thalassemia in 4 (4%). After the initial VTE event, 32 patients received a vitamin K antagonist (VKA), 34 for low-molecular-weight heparin (LMWH), and 43 for direct oral anticoagulants (DOACs). 16 patients (15%) experienced a clinically significant bleeding event, including 9 on VKA, 5 on LMWH, and 2 on DOACs. At a median follow-up of 11.8 (range, 3.4–60) months, 33 patients had a recurrent VTE, including 10 on VKA, 10 on LMWH, and 13 on DOACs (p = 0.833). Bleeding incidence was least with the DOACs, which were associated with fewer bleeding events (OR 0.22), and greatest with VKA (OR 1.55) (p < 0.05). Conclusion: There was no difference between VTE recurrence and choice of anticoagulation in SCD patients with VTE. Bleeding events were lower for DOACs compared to VKA or LMWH.
References
1.
Stein
PD
, Beemath
A
, Meyers
FA
, Skaf
E
, Olson
RE
. Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease
. Am J Med
. 2006
Oct
;119
(10
):897.e7
–11
.
[PubMed]
0002-93432.
Ataga
KI
, Key
NS
. Hypercoagulability in sickle cell disease: new approaches to an old problem
. Hematology (Am Soc Hematol Educ Program)
. 2007
;2007
(1
):91
–6
.
[PubMed]
1520-43913.
Yu
TT
, Nelson
J
, Streiff
MB
, Lanzkron
S
, Naik
RP
. Risk factors for venous thromboembolism in adults with hemoglobin SC or Sβ(+) thalassemia genotypes
. Thromb Res
. 2016
May
;141
:35
–8
.
[PubMed]
0049-38484.
Brunson
A
, Lei
A
, Rosenberg
AS
, White
RH
, Keegan
T
, Wun
T
. Increased incidence of VTE in sickle cell disease patients: risk factors, recurrence and impact on mortality
. Br J Haematol
. 2017
Jul
;178
(2
):319
–26
.
[PubMed]
0007-10485.
Naik
RP
, Streiff
MB
, Haywood
C
Jr, Nelson
JA
, Lanzkron
S
. Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication
. Am J Med
. 2013
May
;126
(5
):443
–9
.
[PubMed]
0002-93436.
Naik
RP
, Streiff
MB
, Lanzkron
S
. Sickle cell disease and venous thromboembolism: what the anticoagulation expert needs to know
. J Thromb Thrombolysis
. 2013
Apr
;35
(3
):352
–8
.
[PubMed]
0929-53057.
Wun
T
, Brunson
A
. Sickle cell disease: an inherited thrombophilia
. Hematology (Am Soc Hematol Educ Program)
. 2016
Dec
;2016
(1
):640
–7
.
[PubMed]
1520-43918.
Chaplin
H
Jr, Monroe
MC
, Malecek
AC
, Morgan
LK
, Michael
J
, Murphy
WA
. Preliminary trial of minidose heparin prophylaxis for painful sickle cell crises
. East Afr Med J
. 1989
Sep
;66
(9
):574
–84
.
[PubMed]
0012-835X9.
Salvaggio
JE
, Arnold
CA
, Banov
CH
. Long-term anti-coagulation in sickle-cell disease. A clinical study
. N Engl J Med
. 1963
Jul
;269
(4
):182
–6
.
[PubMed]
0028-479310.
Liu
X
, Johnson
M
, Mardekian
J
, Phatak
H
, Thompson
J
, Cohen
AT
. Apixaban Reduces Hospitalizations in Patients With Venous Thromboembolism: An Analysis of the Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy (AMPLIFY) Trial
. J Am Heart Assoc
. 2015
Dec
;4
(12
):e002340
.
[PubMed]
2047-998011.
Bauersachs
R
, Berkowitz
SD
, Brenner
B
, Buller
HR
, Decousus
H
, Gallus
AS
, et al; EINSTEIN Investigators
. Oral rivaroxaban for symptomatic venous thromboembolism
. N Engl J Med
. 2010
Dec
;363
(26
):2499
–510
.
[PubMed]
0028-479312.
Kearon
C
, Akl
EA
, Ornelas
J
, Blaivas
A
, Jimenez
D
, Bounameaux
H
, et al Antithrombotic therapy for VTE disease
. Chest
. 2016
Feb
;149
(2
):315
–52
.
[PubMed]
0012-369213.
Ogunsile
FJ
, Naik
R
, Lanzkron
S
. Overcoming challenges of venous thromboembolism in sickle cell disease treatment
. Expert Rev Hematol
. 2019
Mar
;12
(3
):173
–82
.
[PubMed]
1747-408614.
Shet
AS
, Wun
T
. How I diagnose and treat venous thromboembolism in sickle cell disease. blood. 2018
;132(17):1761-9.15.
Schulman
S
, Kearon
C
; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis
. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients
. J Thromb Haemost
. 2005
Apr
;3
(4
):692
–4
.
[PubMed]
1538-793316.
Agnelli
G
, Buller
HR
, Cohen
A
, Curto
M
, Gallus
AS
, Johnson
M
, et al; AMPLIFY Investigators
. Oral apixaban for the treatment of acute venous thromboembolism
. N Engl J Med
. 2013
Aug
;369
(9
):799
–808
.
[PubMed]
0028-479317.
Naik
RP
, Streiff
MB
, Haywood
C
Jr, Segal
JB
, Lanzkron
S
. Venous thromboembolism incidence in the Cooperative Study of Sickle Cell Disease
. J Thromb Haemost
. 2014
Dec
;12
(12
):2010
–6
.
[PubMed]
1538-793318.
Jeng
MR
, Feusner
J
, Skibola
C
, Vichinsky
E
. Central venous catheter complications in sickle cell disease
. Am J Hematol
. 2002
Feb
;69
(2
):103
–8
.
[PubMed]
0361-860919.
Agnelli
G
, Buller
HR
, Cohen
A
, Curto
M
, Gallus
AS
, Johnson
M
, et al; AMPLIFY-EXT Investigators
. Apixaban for extended treatment of venous thromboembolism
. N Engl J Med
. 2013
Feb
;368
(8
):699
–708
.
[PubMed]
0028-479320.
Weitz
JI
, Lensing
AW
, Prins
MH
, Bauersachs
R
, Beyer-Westendorf
J
, Bounameaux
H
, et al; EINSTEIN CHOICE Investigators
. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism
. N Engl J Med
. 2017
Mar
;376
(13
):1211
–22
.
[PubMed]
0028-479321.
Kelley
D
, Jones
LT
, Wu
J
, Bohm
N
. Evaluating the safety and effectiveness of venous thromboembolism prophylaxis in patients with sickle cell disease
. J Thromb Thrombolysis
. 2017
May
;43
(4
):463
–8
.
[PubMed]
0929-5305© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
