P1467: the employment of direct oral anticoagulants in patients affected by β-thalassemia: a multicenter analysis from the extension-myocardial iron overload in thalassemia network (e-miot)

Topic: 27. Thalassemias 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 anticoagulant treatment in the management of PTs with BT and there is limited experience regarding the use of direct oral anticoagulants (DOACs) which may deteriorate liver function, often already impaired in BT for secondary hemosiderosis. Aims: The main of the study was to evaluate the employment of DOACs in clinical practice. Methods: We herein have performed a multicenter retrospective analysis of patients 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 are reported as median (Interquartile Range) for continuous variables and as frequencies n° (%) for categorical variables. Results: Fifty-five PTs were evaluated (Table 1). Thirty-two out of 55 PTs started DOACs as frontline anticoagulant treatment and 23 PTs were shifted from vitamin k antagonist (VKA) therapy. Apixaban and rivaroxabann were the most frequently adopted DOACs. The median time of treatment was 52.5 months (IQR,31.5-72), during follow-up 3 PTs developed superficial vein thrombosis (SVT) and 1 intestinal ischemia, major bleeding was not reported also in those subjects under concomitant antiplatelet drugs (Table 1). VTE recurrences under DOACs were treated low-molecular-weight-heparin (LMWH) for a mean of four weeks, DOACs resulted well tolerated and they were not discontinued or dose-reduced in any subject Summary/Conclusion: 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 complicationsKeywords: Thalassemia