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High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with Vitamin K antagonists
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- De Stefano, V. (author)
- Catholic University of the Sacred Heart, Rome
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- Ruggeri, M. (author)
- Ospedale San Bortolo
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- Cervantes, F. (author)
- Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS)
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- (creator_code:org_t)
- 2016-04-26
- 2016
- English 7 s.
- In: Leukemia. - : Springer Science and Business Media LLC. - 0887-6924 .- 1476-5551. ; 30:10, s. 2032-2038
- Journal article (peer-reviewed)
Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Hematologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Hematology (hsv//eng)
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- De Stefano, V.
- Ruggeri, M.
- Cervantes, F.
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- Elli, E.
- Finazzi, M. C.
- Finazzi, G.
- Zetterberg, E.
- Vianelli, N.
- Gaidano, G.
- Rossi, E.
- Betti, S.
- Nichele, I.
- Cattaneo, D.
- Palova, M.
- Ellis, M. H.
- Cacciola, R.
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- Pungolino, E.
- Specchia, G.
- Rapezzi, D.
- Forcina, A.
- Musolino, C.
- Carobbio, A.
- Griesshammer, M.
- Sant'Antonio, E.
- Vannucchi, A. M.
- Barbui, T.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
- MEDICAL AND HEAL ...
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- and Hematology
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- Leukemia
- By the university
- Lund University
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