Non-Vitamin K Antagonist Oral Anticoagulants in Patients with β-Thalassemia

SIMPLE SUMMARY: β-thalassemia is an inherited disorder characterized by the absent or reduced production of the β-chains of the hemoglobin. The natural history of the disease is radically changed after the introduction of iron chelation therapy, which prolongs life expectancy but also allows new comorbidities to become more prevalent. Among these comorbidities, atrial fibrillation is emerging as a clinical challenge since thalassemic patients show both higher ischemic and bleeding risk. Despite the worldwide adoption of NOACs in the general population, their use in thalassemic patients has been only described in case series and reports. The aim of the present study was to evaluate the efficacy and safety of NOACs in this cohort of patients. We enrolled 18 patients with transfusion-dependent β-thalassemia on treatment with NOACs for thromboembolic prophylaxis of supraventricular arrhythmias. During a mean follow-up duration of 22 ± 15 months, no thromboembolic events were reported, and no major bleedings were observed. The results of our study suggest the efficacy and safety of NOACs treatment in β-thalassemic patients. Given the increase in prevalence of atrial fibrillation in this cohort of patients, our results add an additional piece to the current state of knowledge and daylight practice. ABSTRACT: Background. Patients with β-thalassemia have a high incidence of atrial fibrillation (AF) and other supraventricular arrhythmias. The use of non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prophylaxis in patients with β-thalassemia has not been systematically evaluated. Methods. We enrolled patients with transfusion-dependent β-thalassemia, who were on treatment with NOACs for thromboembolic prophylaxis of supraventricular arrhythmias. Data on thromboembolic and bleeding events were collected. Results. Eighteen patients were enrolled. The patients had a history of AF (sixteen), typical atrial flutter (five), and atypical atrial flutter (four). The patients were treated with dabigatran (seven), apixaban (five), rivaroxaban (four) or edoxaban (two). The mean follow-up duration was 22 ± 15 months. No thromboembolic events were reported. No major bleedings were observed. Three patients had non-major bleeding events. Two patients reported dyspepsia during treatment with dabigatran and were shifted to a different NOAC. Conclusions. Our study suggests the efficacy and safety of NOACs in patients affected by transfusion-dependent β-thalassemia.