Imperial College London
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DrCarolynMillar

Faculty of Medicine, Department of Immunology and Inflammation

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 2153c.millar

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Shovlin:2019:10.1186/s13023-019-1179-1,
author = {Shovlin, C and Millar, C and Droege, F and Kjeldsen, A and Manfredi, G and Suppressa, P and Ugolini, S and Coote, N and Fialla, A and Geisthoff, U and Lenato, G and Mager, HJ and Pagella, F and Post, M and Sabba, C and Sure, U and Torring, P and Dupuis, Girod S and Buscarini, E and VASCERN, HHT},
doi = {10.1186/s13023-019-1179-1},
journal = {Orphanet Journal of Rare Diseases},
title = {Safety of direct oral anticoagulants in patients with hereditary hemorrhagic telangiectasia},
url = {http://dx.doi.org/10.1186/s13023-019-1179-1},
volume = {14},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Hereditary  haemorrhagic  telangiectasia  (HHT)  is  a  rare  vascular  dysplasia  resulting  in visceral arteriovenous malformations and smaller mucocutaneous telangiectasia.  Most patients experience recurrent nosebleeds   and   become   anaemic   without   iron   supplementation.      However,   thousands may   require anticoagulation  for  conditions  such  as  venous  thromboembolismand/or  atrial  fibrillation.   Over  decades,tolerance data has been publishedfor almost 200HHT-affected usersof warfarinand heparins, but there are no publisheddata forthe newer direct oralanticoagulants(DOACs)in HHT. Methods: To  provide  such data,  aretrospective  audit  was  conducted  across the  eight  HHT  centres  of  the European  Reference  Network  for  Rare  Vascular  Disorders  (VASCERN),in  Denmark,  France,  Germany,  Italy, Netherlands and UK.  Results:   Although HHT Centreshad not specifically recommended the use of DOACs, 32treatment episodes had been initiated by other cliniciansin 28patients reviewed at the centres, at median age 65years(range 30-84). Indications were for atrial fibrillation (16 treatment episodes) and venous thromboembolism (16 episodes).The 32 treatment episodes used Apixaban (n=15), Rivaroxaban (n=14), and Dabigatran (n=3). HHT nosebleeds increased  in  severity  in 24/32 treatment  episodes  (75%),  leading  to  treatment discontinuation  in 11 (34.4%). Treatment  discontinuation  was  required for 4/15(26.7%)  Apixabanepisodes and 7/14  (50%)Rivaroxaban episodes.By  a 4 point  scale of increasing severity,there  was a trend for Rivaroxaban to be associated with a greaterbleeding riskboth including and excluding patients who had used more than one agent (age-adjusted coefficients  0.61  (95%  confidence  intervals  0.11,  1.20)  and  0.74  (95%  confidence  intervals  0.12,  1.36) respectively.   Associationswere maintained after adjustment for genderand treatment indication.  Extreme haemorrhagic responses, worse thananything
AU  - Shovlin,C
AU  - Millar,C
AU  - Droege,F
AU  - Kjeldsen,A
AU  - Manfredi,G
AU  - Suppressa,P
AU  - Ugolini,S
AU  - Coote,N
AU  - Fialla,A
AU  - Geisthoff,U
AU  - Lenato,G
AU  - Mager,HJ
AU  - Pagella,F
AU  - Post,M
AU  - Sabba,C
AU  - Sure,U
AU  - Torring,P
AU  - Dupuis,Girod S
AU  - Buscarini,E
AU  - VASCERN,HHT
DO  - 10.1186/s13023-019-1179-1
PY  - 2019///
SN  - 1750-1172
TI  - Safety of direct oral anticoagulants in patients with hereditary hemorrhagic telangiectasia
T2  - Orphanet Journal of Rare Diseases
UR  - http://dx.doi.org/10.1186/s13023-019-1179-1
UR  - http://hdl.handle.net/10044/1/72826
VL  - 14
ER  -
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