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

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@article{dcc01f4ef69d4160b647428b2ceaa8df,
title = "High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with Vitamin K antagonists",
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.",
author = "{De Stefano}, V. and M. Ruggeri and F. Cervantes and A. Alvarez-Larran and A. Iurlo and Randi, {M. L.} and E. Elli and Finazzi, {M. C.} and G. Finazzi and E. Zetterberg and N. Vianelli and G. Gaidano and E. Rossi and S. Betti and I. Nichele and D. Cattaneo and M. Palova and Ellis, {M. H.} and R. Cacciola and A. Tieghi and Hernandez-Boluda, {J. C.} and E. Pungolino and G. Specchia and D. Rapezzi and A. Forcina and C. Musolino and A. Carobbio and M. Griesshammer and E. Sant'Antonio and Vannucchi, {A. M.} and T. Barbui",
year = "2016",
month = "10",
day = "1",
doi = "10.1038/leu.2016.85",
language = "English",
volume = "30",
pages = "2032--2038",
journal = "Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K",
issn = "1476-5551",
publisher = "Nature Publishing Group",
number = "10",

}