High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with Vitamin K antagonists

Valerio De Stefano, Elena Rossi, Silvia Betti, M. Ruggeri, F. Cervantes, A. Alvarez-Larrán, A. Iurlo, M. L. Randi, E. Elli, M. C. Finazzi, G. Finazzi, E. Zetterberg, N. Vianelli, G. Gaidano, I. Nichele, D. Cattaneo, M. Palova, M. H. Ellis, R. Cacciola, A. TieghiJ. C. Hernandez-Boluda, E. Pungolino, G. Specchia, D. Rapezzi, A. Forcina, C. Musolino, A. Carobbio, M. Griesshammer, E. Sant'Antonio, A. M. Vannucchi, T. Barbui

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

40 Citazioni (Scopus)

Abstract

The optimal duration of treatment with vitamin K antagonists (VKA) after venous thromboembolism (VTE) in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) is uncertain. To tackle this issue, we retrospectively studied 206 patients with MPN-related VTE (deep venous thrombosis of the legs and/or pulmonary embolism). After this index event, we recorded over 695 pt-years 45 recurrences, venous in 36 cases, with an incidence rate (IR) of 6.5 per 100 pt-years (95% confidence interval (CI): 4.9-8.6). One hundred fifty-five patients received VKA; the IR of recurrent thrombosis per 100 pt-years was 4.7 (95% CI: 2.8-7.3) on VKA and 8.9 (95% CI: 5.7-13.2) off VKA (P=0.03). In patients receiving VKA, the IR of recurrent thrombosis per 100 pt-years was 5.3 (95% CI: 3.2-8.4) among 108 patients on long-term VKA and 12.8 (95% CI: 7.3-20.7) after discontinuation among the 47 who ceased treatment (P=0.008), with a doubled risk of recurrence after stopping VKA (hazard ratio: 2.21, 95% CI: 1.19-5.30). The IR of major bleeding per 100 pt-years was 2.4 (95%: CI: 1.1-4.5) on VKA and 0.7 (95% CI: 0.08-2.5) off VKA (P=0.08). In conclusion, in MPN patients with VTE recurrent thrombosis is significantly reduced by VKA and caution should be adopted in discontinuation; however, the incidence of recurrence on treatment remains high, calling for clinical trials aimed to improve prophylaxis in this setting.
Lingua originaleEnglish
pagine (da-a)2032-2038
Numero di pagine7
RivistaLeukemia
Volume30
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • Hematology

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