Dr. Nagalla on Aspirin Use During DOAC Treatment for MPNs

Srikanth Nagalla, MD, director, Hematology Oncology Fellowship Program, Harold C. Simmons Comprehensive Cancer Center, and associate professor of medicine, UT Southwestern Medical Center, discusses aspirin recommendations for patients with myeloproliferative neoplasms (MPNs) who are receiving direct oral anticoagulants (DOACs).

When aspirin is used for something without an indication in patients who are already taking a DOAC, the risk of bleeding is increased, explains Nagalla. Three articles published in the New England Journal of Medicine in 2018 stated that aspirin should not be used if no clear indication for primary prophylaxis exists.

Previously, it was assumed that any patient with a MPN above age 40 could take a baby aspirin, but the field has since have moved away from that assumption, says Nagalla. Patients who are on a DOAC should not receive aspirin if there is no clear indication for it. In the MPN study that examined the use of aspirin concomitantly with a DOAC, 3 patients experienced bleeding. DOACs, at least in this small retrospective study, were effective in preventing thrombosis in patients with MPNs, concludes Nagalla.