Direct oral anticoagulant medications in calciphylaxis.

Abstract

BACKGROUND:

Recent studies suggest that calciphylaxis is a thrombotic condition in which arteriolar thrombosis leads to painful skin infarcts and consequent morbidity and mortality. Paradoxically, warfarin is implicated as a risk factor for calciphylaxis. Our objective is to report the use of oral direct thrombin and factor Xa inhibitors (termed direct oral anticoagulants [DOACs]) in patients with calciphylaxis.

METHODS:

We retrospectively reviewed records of 16 patients with calciphylaxis who received concomitant administration of novel anticoagulants. Patient data, including demographics, comorbidities, other treatments, and adverse events, were abstracted from the health records.

RESULTS:

Eleven patients (69%) had chronic kidney disease (stage ≥3A), and eight (50%) received dialysis. Apixaban was the most frequently used agent (n = 11 [69%]). Dabigatran (n = 4 [25%]) and rivaroxaban (n = 2 [13%]) were reserved for patients with mild renal impairment (stage ≤2). One clinically relevant but nonmajor bleeding event occurred. There were no major bleeding events. Nine patients (56%) were alive at last follow-up, and five (31%) had complete resolution of their calciphylaxis (mean follow-up, 523 days; range, 26-1884 days).

CONCLUSION:

DOACs were safe and well tolerated in patients with calciphylaxis, in this initial experience. Several patients had improvement or resolution of calciphylaxis in response to therapy that included DOACs. The degree of renal impairment should guide DOAC choice. Randomized trials are required to determine treatment efficacy.

• Authors: Brian J King, Rokea A El-Azhary, Marian T McEvoy, Raymond C Shields, Robert D McBane, James T McCarthy, Mark D P Davis
• Journal: International journal of dermatology (Int J Dermatol) Vol. 56 Issue 10 Pg. 1065-1070 (Oct 2017) ISSN: 1365-4632 [Electronic] England
• PMID: 28856671 (Publication Type: Journal Article)
• Copyright: © 2017 The International Society of Dermatology.

Chemical References

• Anticoagulants
• Pyrazoles
• Pyridones
• apixaban
• Rivaroxaban
• Dabigatran

Topics

• Adult
• Aged
• Anticoagulants (adverse effects, therapeutic use)
• Calciphylaxis (complications, drug therapy)
• Dabigatran (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Pyrazoles (therapeutic use)
• Pyridones (therapeutic use)
• Renal Insufficiency, Chronic (complications)
• Retrospective Studies
• Rivaroxaban (therapeutic use)