Thrombosis is common in paroxysmal nocturnal hemoglobinuria (PNH), but physicians must weigh direct oral anticoagulants (DOACs) as a preventive strategy against the risk for bleeding, according to findings published in Blood. Cynthia Wu, MD, and colleagues assessed the epidemiology and management of 31 adult patients with PNH (median age, 50). Nearly half the study population (48%) had concurrent aplastic anemia. Of the 42% of patients on anticoagulation, 23% received primary prophylaxis, while 19% were treated with secondary prophylaxis. Approximately a fifth of all patients receiving prophylaxis also took DOACs. One breakthrough arterial thromboembolism was reported among patients on a DOAC. “DOACs appear to be effective against [venous thromboembolism] with no occurrence of breakthrough venous thrombosis,” Dr. Wu and colleagues wrote. “Major bleeding complications were observed at a higher rate than has been described in the literature, and therefore, the use of anticoagulants in this patient population must be weighed against the bleeding risk.”