# Management of venous thrombosis in sickle cell disease: a comparative study on the use of direct oral anticoagulants and warfarin

## TL;DR

This study compares the effectiveness of DOACs and warfarin in treating venous thrombosis in sickle cell disease patients, finding similar outcomes but fewer bleeding issues with DOACs.

## Contribution

The study provides new comparative evidence on DOACs versus warfarin for managing thrombosis in sickle cell disease patients.

## Key findings

- No significant difference in recurrent thrombosis or major bleeding between DOACs and warfarin.
- Clinically relevant nonmajor bleeding was significantly lower with DOACs.
- DOACs showed similar clinical outcomes but fewer bleeding complications compared to warfarin.

## Abstract

Sickle cell disease (SCD) is associated with an increased risk of thrombosis and often leads to mortality.

This study aimed to compare the clinical outcomes of direct oral anticoagulants (DOACs) with warfarin in the management of patients with SCD and first venous thrombosis.

This retrospective study included adult patients aged ≥ 18 years with SCD who developed their first episode of venous thrombotic event. Recurrent thrombosis and bleeding were compared between patients treated with DOACs and warfarin. Data were analyzed using IBM Statistical Package for the Social Sciences version 21.

We included 99 patients, of whom 67 (67.7%) were treated with DOACs and 32 (32.3%) with warfarin. The median follow-up time was 44 (1-130) months. Pulmonary embolism was the most common type of thrombosis observed in 64 patients (64.6 %). Three patients developed recurrent venous thromboembolism within 6 months of the first episode, whereas 6 patients developed recurrent thrombosis after 1 year. No significant difference was noted among patients on either type of anticoagulation in terms of major bleeding episodes (OR = 1.1; 95% CI: 1.1-1.8; P: 1.00), recurrence of thrombosis (OR = 0.68; 95% CI: 0.03-11.2; P: .68), or mortality (OR = 0.46; 95% CI: 0.06-3.4; P: .59). Clinically relevant nonmajor bleeding was significantly lower in patients on DOACs than those on warfarin (OR = 0.06; 95% CI: 0.01-0.52; P: .01).

DOACs are associated with similar clinical outcomes and fewer bleeding complications as compared to warfarin in the management of patients with SCD and thrombosis. Randomized controlled trials are required to further confirm our findings.

•Data on the use of direct oral anticoagulants (DOACs) in patients with sickle cell disease and venous thrombosis are limited.•We aimed to compare DOACs and warfarin in sickle cell disease patients with venous thrombosis.•No significant difference between DOACs and warfarin in terms of recurrent thrombosis and major bleeding.•Clinically relevant nonmajor bleeding is significantly lower with the use of DOACs.

Data on the use of direct oral anticoagulants (DOACs) in patients with sickle cell disease and venous thrombosis are limited.

We aimed to compare DOACs and warfarin in sickle cell disease patients with venous thrombosis.

No significant difference between DOACs and warfarin in terms of recurrent thrombosis and major bleeding.

Clinically relevant nonmajor bleeding is significantly lower with the use of DOACs.