Anticoagulation therapy with DOACs in sickle cell disease: a systematic review and meta-analysis

Direct oral anticoagulants (DOACs) are widely used for treating venous thromboembolism (VTE). However, uncertainty remains regarding their use among individuals diagnosed with sickle cell disease (SCD), as this population was primarily excluded from pivotal trials establishing DOAC safety and therapeutic success. We evaluated the clinical utility and safety profile of DOACs in patients with SCD. PubMed, Scopus, and the Cochrane Library were searched without language restrictions. Quantitative synthesis was carried out utilizing MetaXL and Review Manager version 5.4. Primary outcomes of interest were the clinical success and safety profile of DOAC therapy for individuals with SCD. Odds ratios (ORs) were used as measures of effect, and statistical variance was evaluated via the I-squared metric, where values exceeding 50% suggested considerable variation. Of 296 identified articles, five studies were included, comprising 312 patients. Among them, 167 received DOACs, 110 warfarin, 44 low-molecular-weight heparin (LMWH), and two fondaparinux. Administering DOACs as antithrombotic treatment led to a notable decrease in the likelihood of major bleeding in comparison with warfarin (OR = 0.24; 95% CI, 0.07–0.81; p = 0.02). No significant difference was observed in subsequent VTE episodes when comparing DOAC-managed SCD cohorts to those receiving warfarin (OR = 0.94; 95% CI, 0.49–1.80; p = 0.86) or LMWH (OR = 1.19; 95% CI, 0.50–2.83; p = 0.69). DOACs appear to be an equally effective, safer, and practical alternative for managing thrombotic conditions among individuals diagnosed with SCD. Not applicable.