What are the ASH guidelines on the management of venous thromboembolism in patients with sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The ASH panel considers SCD to be a chronic underlying risk factor for initial and recurrent venous thromboembolism (VTE). Consequently, for adults with SCD and first unprovoked VTE, the ASH guideline panel suggests indefinite anticoagulation over shorter, defined periods of anticoagulation.

For adults with SCD and first provoked VTE (whether surgically or nonsurgically provoked), the ASH guideline panel suggests defined periods of anticoagulation (3-6 months) over indefinite anticoagulation. Anticoagulation should continue as long as any provoking risk factor (eg, a central venous line) continues to be present.

In adults with SCD and recurrent provoked VTE, the ASH guideline panel suggests indefinite anticoagulation. However, the type, strength, and duration of the provoking events are important to take into account when considering indefinite anticoagulation for those patients.

Whether to continue anticoagulation should be re-evaluated regularly, and should involve shared decision-making based on patient values and preferences. Discussions of the benefits vs harms of anticoagulation, as well as duration of therapy, should take into consideration bleeding risk, including from existing use of other medications that could further increase risk of bleeding (eg, nonsteroidal anti-inflammatory drugs).

Anticoagulant selection for patients with SCD should account for comorbidities such as renal impairment that may affect drug clearance. For example, because of the potential for decreased efficacy of edoxaban in the setting of increased creatinine clearance (CrCl), alternative anticoagulants should be considered for SCD patients with CrCl of > 95 mL/min.


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