Secondary prevention of thrombosis with direct oral anticoagulants for hereditary hematogenous thrombophilia

Aim. The article describes the experience of using direct oral anticoagulants – drugs Dabigatran, Rivaroxaban and Apixaban for the secondary prevention of thrombosis in patients with the most common variants of hereditary hematogenous thrombophilia.

Materials and methods. 86 patients were under observation: 53 men, 33 women. Only the registered fact of thrombosis, thromboembolism, ischemia or organ infarction was the basis for the diagnosis of hematogenous thrombophilia and further secondary prevention of thrombosis. In 80 cases, there was a combined form of thrombophilia. In addition to hereditary factors, there were acquired thrombogenic factors. Dabigatran etexilate (Pradaxa®) for the prevention of thrombus formation was prescribed to 41 patients aged 20 to 60 years; duration of admission from 12 months to 9 years, the dose of the drug was selected individually from 150 to 300 mg per day. Rivaroxaban (Xarelto®) for the prevention of thrombus formation was prescribed to 25 patients aged 18 to 54 years, duration of admission from 12 months to 7 years, the dose of the drug is 10-20 mg per day. Apixaban (Eliquis®) was prescribed to 10 patients, aged 30 to 50 years, the duration of admission was from 6 months up to 2 years, dosage 5-10 mg per day. For hyperhomocysteinemia, Angiovit® or Pentavit® was prescribed. Protein C and antithrombin III preparations with their congenital deficiency were used according to indications.

Results. After Dabigatran was prescribed, only one patient had a recurrent pulmonary embolism due to low adherence to treatment. In other patients who were prescribed direct oral anticoagulants, no recurrence of thrombotic complications was recorded. No hemorrhagic complications were diagnosed with the use of Dabigatran and Apixaban. In 5 patients receiving Rivaroxaban, there were minor epistaxis; in three cases they stopped when the dose was reduced from 20 to 15-10 mg, two patients were transferred to dabigatran. No life-threatening bleeding has been reported.

Conclusion. Dabigatran, Rivaroxaban and Apixaban are effective and safe drugs for antithrombotic therapy. The absence of the need for constant laboratory monitoring and extremely rare hemorrhagic complications makes it possible to use them in patients living in areas remote from large medical centers. Only 10 patients under our supervision with a diagnosis of “hematogenous thrombophilia” are currently taking warfarin. Timely diagnosis of the variant of hematogenous thrombophilia and the appointment of adequate anti-thrombotic therapy contributes to the relapse-free course of the disease.

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