High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists.
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.
Institute of Hematology, Catholic University, Roma, Italy.
V
V
De Stefano
Ospedale San Bortolo, Vicenza, Italy.
M
M
Ruggeri
Hospital Clínic, IDIBAPS, Barcelona, Spain.
F
F
Cervantes
Hematology Department, Hospital del Mar, Barcelona, Spain.
A
A
Alvarez-Larrán
Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
A
A
Iurlo
A.O. Universitaria, Padova, Italy.
M L
ML
Randi
Hematology Division, A.O. San Gerardo, Monza, Italy.
E
E
Elli
Hematology Division, A.O. Papa Giovanni XXIII, Bergamo, Italy.
M C
MC
Finazzi
Hematology Division, A.O. Papa Giovanni XXIII, Bergamo, Italy.
G
G
Finazzi
Department of Hematology and Vascular Disorders, Skane University Hospital, Lund, Sweden.
E
E
Zetterberg
Università di Bologna, Bologna, Italy.
N
N
Vianelli
Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
G
G
Gaidano
Institute of Hematology, Catholic University, Roma, Italy.
E
E
Rossi
Institute of Hematology, Catholic University, Roma, Italy.
S
S
Betti
Ospedale San Bortolo, Vicenza, Italy.
I
I
Nichele
Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
D
D
Cattaneo
University Hospital of Olomouc, Olomouc, Czech Republic.
M
M
Palova
Meir Medical Center, Hematology Institute, Kefar Sava, Israel.
M H
MH
Ellis
A.O. Universitaria, Catania, Italy.
R
R
Cacciola
Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
A
A
Tieghi
Hospital Clinico, Valencia, Spain.
J C
JC
Hernandez-Boluda
A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
E
E
Pungolino
A.O. Universitaria, Bari, Italy.
G
G
Specchia
A.O. Santa Croce e Carle, Cuneo, Italy.
D
D
Rapezzi
IRCCS Ospedale San Raffaele, Milano, Italy.
A
A
Forcina
A.O. Universitaria, Messina, Italy.
C
C
Musolino
FROM Research Foundation, A.O. Papa Giovanni XXIII, Bergamo, Italy.
A
A
Carobbio
J. W. Klinikum, Minden, Germany.
M
M
Griesshammer
Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Firenze, Italy.
E
E
Sant'Antonio
Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Firenze, Italy.
A M
AM
Vannucchi
FROM Research Foundation, A.O. Papa Giovanni XXIII, Bergamo, Italy.
T
T
Barbui
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019046:Bone Marrow Neoplasms / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000150:complications; D011292:Premedication / Q000379:methods*; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000209:etiology; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D005343:Fibrinolytic Agents; D014812:Vitamin K