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Leukemia. 2016 Oct;30(10):2032-2038. doi: 10.1038/leu.2016.85. Epub 2016 Apr 26.

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

Author information

1
Institute of Hematology, Catholic University, Roma, Italy.
2
Ospedale San Bortolo, Vicenza, Italy.
3
Hospital Clínic, IDIBAPS, Barcelona, Spain.
4
Hematology Department, Hospital del Mar, Barcelona, Spain.
5
Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
6
A.O. Universitaria, Padova, Italy.
7
Hematology Division, A.O. San Gerardo, Monza, Italy.
8
Hematology Division, A.O. Papa Giovanni XXIII, Bergamo, Italy.
9
Department of Hematology and Vascular Disorders, Skane University Hospital, Lund, Sweden.
10
Università di Bologna, Bologna, Italy.
11
Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
12
University Hospital of Olomouc, Olomouc, Czech Republic.
13
Meir Medical Center, Hematology Institute, Kefar Sava, Israel.
14
A.O. Universitaria, Catania, Italy.
15
Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
16
Hospital Clinico, Valencia, Spain.
17
A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
18
A.O. Universitaria, Bari, Italy.
19
A.O. Santa Croce e Carle, Cuneo, Italy.
20
IRCCS Ospedale San Raffaele, Milano, Italy.
21
A.O. Universitaria, Messina, Italy.
22
FROM Research Foundation, A.O. Papa Giovanni XXIII, Bergamo, Italy.
23
J. W. Klinikum, Minden, Germany.
24
Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Firenze, Italy.

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.

PMID:
27113812
DOI:
10.1038/leu.2016.85
[Indexed for MEDLINE]

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