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

Research output: Contribution to journalArticle

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.

Details

Authors
  • V. De Stefano
  • M. Ruggeri
  • F. Cervantes
  • A. Alvarez-Larran
  • A. Iurlo
  • M. L. Randi
  • E. Elli
  • M. C. Finazzi
  • G. Finazzi
  • 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. Sant'Antonio
  • A. M. Vannucchi
  • T. Barbui
Organisations
External organisations
  • Catholic University of the Sacred Heart
  • Ospedale San Bortolo
  • Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS)
  • Hospital del Mar Medical Research Institute
  • Maggiore Hospital Policlinico
  • Skåne University Hospital
  • University of Bologna
  • University of Eastern Piedmont
  • University Hospital of Olomouc
  • Meir Medical Center
  • Arcispedale Santa Maria Nuova
  • University and Polytechnic Hospital la Fe
  • Niguarda Hospital
  • A.O. Santa Croce e Carle
  • San Raffaele Scientific Institute
  • Ospedale Papa Giovanni XXIII
  • University Hospital of Padua
  • San Gerardo Hospital
  • Bari University Hospital
  • Azienda Ospedaliera Universitaria Policlinico "G. Martino"
  • Johannes Wesling Klinikum Minden
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology
Original languageEnglish
Pages (from-to)2032-2038
Number of pages7
JournalLeukemia
Volume30
Issue number10
Publication statusPublished - 2016 Oct 1
Publication categoryResearch
Peer-reviewedYes