Direct oral anticoagulants for deep vein thrombosis among patients with hereditary thrombophilia—A cohort study

Abstract

Objectives to evaluate direct oral anticoagulants (DOACs) in patients with hereditary thrombophilia and deep venous thrombosis (DVT). Methods This is a retrospective observational study. Results In total, 45 patients were treated between 01/2012 and 12/2022 (mean follow-up: 1.5 +/− 0.3 years). The most frequent thrombophilias were heterozygous V Leiden (20%), heterozygous MTHFR C677T (37.8%), heterozygous MTHFR A1298C (24.4%), and hyperhomocysteinemia (26.7%). The patients received rivaroxaban ( n = 19), apixaban ( n = 15), and dabigatran ( n = 11). Three cases presented symptoms’ recurrence without evidence of thrombosis’ recurrence (two under rivaroxaban and one under apixaban; p > .05). These patients improved under parenteral anticoagulation and were further treated with dabigatran. No other event or major bleeding occurred during the follow-up. The presence of more than two factors was associated with acute recurrence of symptoms (OR = 25.9; 95% CI [1.454–461.262]; p = .026). Conclusions DOACs seem to be safe and efficient for patients with hereditary thrombophilia and DVT. The presence of more than two thrombophilia factors is associated with a higher risk for symptom recurrence. Although statistically non-significant, symptoms’ recurrence was also observed more frequently among patients under anti-Xa inhibitors than antithrombin inhibitors. This should be verified in larger comparative studies.