| HOME | HELP | FEEDBACK | TABLE OF CONTENTS | ARCHIVE | SUBSCRIPTIONS |
|
|
|
||||||
|
||||||||
Myeloproliferative Disorders |
1 Institute of Hematology, Catholic University, Rome
2 Dept. of Hematology, University of Florence, Florence
3 Hematology Department and Hemophilia and Thrombosis Center, San Bortolo Hospital, Vicenza
4 Hematology Division and Bone Marrow Transplantation Unit, San Gerardo Hospital, University of Milano-Bicocca, Monza
5 Dept. of Hematology-Oncology, Ospedali Riuniti, Bergamo
6 Hematology Unit, Santa Maria Nuova Hospital, Reggio Emilia
7 the Dept. of Biomedical Sciences, Section of Hematology, University of Catania, Catania
8 Institute of Hematology, Dept. of Cellular Biotechnology and Hematology, University La Sapienza, Rome
9 Hematology and Thrombosis Unit, San Paolo Hospital, University of Milan, Milan
10 Institute of Hematology and Oncology L. and A. Seràgnoli, University of Bologna, Bologna
11 Laboratory of Epidemiology of Cardiovascular Disease, Dept. of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
Correspondence: Valerio De Stefano, Institute of Hematology, Catholic University, Largo Gemelli 8, 00168 Rome, Italy. E-mail: valerio.destefano{at}rm.uni-catt.it
Background: Prior thrombosis is a well-established risk factor for re-thrombosis in polycythemia vera and essential thrombocythemia but scarce data are available on the rate of re-thrombosis and the optimal strategy for prevention of recurrence.
Design and Methods: We retrospectively estimated the rate of recurrence in a multicenter cohort of 494 patients (poly-cythemia vera/essential thrombocythemia 235/259) with previous arterial (67.6%) or venous thrombosis (31%) or both (1.4%). First thrombosis was cerebrovascular disease in 191 cases, acute coronary syndrome in 106, peripheral arterial thrombosis in 44, and venous thromboembolism in 160. Microcirculatory events were not computed.
Results: Thrombosis recurred in 166 patients (33.6%), with an incidence of 7.6% patient-years. Sex, diagnosis (polycythemia vera or essential thrombocythemia), and presence of vascular risk factors did not predict recurrence, whereas age >60 years did (multivariable hazard ratio [HR], 1.67; 95% confidence interval [CI] 1.19–2.32). Increased leukocyte count at the time of the first thrombosis was a risk factor for recurrence in patients <60 years old (HR 3.55; 95% CI 1.02–12.25). Cytoreduction halved the risk in the overall cohort (HR 0.53; 95% CI 0.38–0.73) and the combination with antiplatelet agents or oral anticoagulants was more effective than administration of single drugs. Significant prevention of rethrombosis was independently achieved in patients with venous thromboembolism by both oral anticoagulants (HR 0.32; 95% CI 0.15–0.64) and antiplatelet agents (HR 0.42; 95% CI 0.22–0.77), in those with acute coronary syndrome by cytoreduction (HR 0.30; 95% CI 0.13–0.68), and in those with cerebrovascular disease by antiplatelet agents (HR 0.33; 95% CI 0.16–0.66). The overall incidence of major bleeding was 0.9% patient-years and rose to 2.8% in patients receiving both antiplatelet and anti-vitamin K agents.
Conclusions: In patients with polycythemia vera and essential thrombocythemia, cytoreduction protects against recurrent thrombosis, particularly after acute coronary syndrome. The contemporary use of oral anticoagulants (after venous thromboembolism) or antiplatelet agents (after cerebrovascular disease or venous thromboembolism) further improves the protective effect. Such findings call for prospective studies aimed at investigating whether strategies tailored according to the type of first thrombosis could improve prevention of recurrences.
Key words: polycythemia vera, essential thrombocythemia, recurrent thrombosis, cytoreductive treatment, antiplatelet treatment, oral anticoagulant treatment.
Related Article
Haematologica 2008 93: 331-335.
This article has been cited by other articles:
|
|
 |
|
  R. Landolfi and L. Di Gennaro Prevention of thrombosis in polycythemia vera and essential thrombocythemia Haematologica, March 1, 2008; 93(3): 331 - 335. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Friedberg Secondary malignancies after therapy of indolent non-Hodgkin's lymphoma Haematologica, March 1, 2008; 93(3): 336 - 338. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | TABLE OF CONTENTS | ARCHIVE | SUBSCRIPTIONS |
