Abstract
Thrombosis and bleeding significantly affect morbidity and mortality in myeloproliferative neoplasms (MPNs). The efficacy and safety of direct oral anticoagulants (DOACs) in MPN patients remain uncertain. In a large, retrospective, nationwide cohort study conducted from 2010 to 2021, 368 MPN patients were analyzed after being newly treated with DOACs for AF or VTE. Of these, 62.8% received DOACs for AF and 37.2% for VTE. The AF group was statistically older with higher CHA2DS2-VASc scores compared to the VTE group. Antiplatelet agents were used in 51.1% of cases, and cytoreductive drugs in 79.3%, with hydroxyurea being the most common (64.9%). The median follow-up was 22.3 months, with one-year cumulative incidence rates of thrombosis and bleeding at 11.1% and 3.7%, respectively. Multivariate analysis identified CHA2DS2-VASc scores ≥ 3 (HR = 3.48), concomitant antiplatelet use (HR = 2.57), and cytoreduction (HR = 2.20) as significant thrombosis risk factors but found no significant predictors for major bleeding. Despite the limitations of retrospective data, DOAC treatment in MPN patients seems effective and has an acceptable bleeding risk.