High Rate of Recurrent Venous Thromboembolism in Patients with Myeloproliferative Neoplasms and Effect of Prophylaxis with Vitamin K Antagonists

Overview

Journal Leukemia

Specialties Hematology
Oncology

Date 2016 Apr 27

PMID 27113812

Citations 38

Authors

V De Stefano

M Ruggeri

F Cervantes

A Alvarez-Larran

A Iurlo

M L Randi

E Elli

M C Finazzi

G Finazzi

E Zetterberg

N Vianelli

G Gaidano

E Rossi

S Betti

I Nichele

D Cattaneo

M Palova

M H Ellis

R Cacciola

A Tieghi

J C Hernandez-Boluda

E Pungolino

G Specchia

D Rapezzi

A Forcina

C Musolino

A Carobbio

M Griesshammer

E SantAntonio

A M Vannucchi

T Barbui

Affiliations

Soon will be listed here.

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.

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