IPIG 2025 | Preventing thrombosis in patients with PNH

Complement inhibition and terminal complement inhibition is the only one that’s been so established – we know that’s highly effective at preventing thrombosis. The question around the use of anticoagulants in these patients is sort of historical and there is still a fair amount of controversy about whether the use of anticoagulants such as warfarin or direct-acting oral anticoagulants or heparinoid agents actually has much place in the management of PNH patients in the modern era. We have to look at areas where complement inhibition is not readily available and for want of something better to do, the use of warfarin or a DOAC in a patient with a high clonal burden is probably a reasonable thing to do but is not without risk. There is a bleeding risk associated with the use of all of these agents so you can’t just assume that you can use them safely. And then there’s an issue of pregnancy which is a different, a whole different ballpark, but most people are so concerned about pregnant women with PNH, even well-controlled on complement inhibition, that heparinoids, low molecular weight heparin, are usually used through pregnancy to try and avoid the potential complications of thrombosis that are at higher risk in that complement-amplified state.

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