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Haematologica. 2016 Aug;101(8):926-31. doi: 10.3324/haematol.2016.146654. Epub 2016 May 12.

Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation.

Author information

1
Hematology Department, Hospital del Mar, IMIM, UAB, Barcelona, Spain 95967@parcdesalutmar.cat.
2
Hematotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain.
3
Center for Research and Innovation of MPN (CRIMM); AOU Careggi, and Department of Experimental and Clinical Medicine, University of Florence, Italy.
4
Hematology Department, Hospital Clínico, Valencia, Spain.
5
Hematology and Medical Oncology Department, Hospital Morales Messeguer, IMIB-Arrixaca, UCAM, Murcia, Spain.
6
Haematology Department, Guys' and St Thomas' NHS Foundation Trust, London, UK.
7
Hematology, Oncology & Palliative Care, Johannes Wesling Academic Medical Center, University of Hannover Teaching Hospital, Germany.
8
Hematology Department, Hospital La Paz, Madrid, Spain.
9
Hematology Section, Uddevalla Hospital, NU Hospital Group, Sweden.
10
Hematology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain.
11
Institute of Hematology & Blood Transfusion, Prague, Czech Republic.
12
Hematology Department, Hospital Ramón y Cajal, Madrid, Spain.
13
Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
14
Hematology Department, Hospital Vall d'Hebron, Barcelona, Spain.
15
Hematology Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain.
16
Division of Hematology, University Hospital Basel, Switzerland.
17
Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
18
Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.
19
Department of Clinical Science and Education, Karolinska Institute, South Hospital, Stockholm, Sweden.
20
Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.
21
Hematology Department, Hospital del Mar, IMIM, UAB, Barcelona, Spain.

Abstract

The role of antiplatelet therapy as primary prophylaxis of thrombosis in low-risk essential thrombocythemia has not been studied in randomized clinical trials. We assessed the benefit/risk of low-dose aspirin in 433 patients with low-risk essential thrombocythemia (271 with a CALR mutation, 162 with a JAK2(V617F) mutation) who were on antiplatelet therapy or observation only. After a follow up of 2215 person-years free from cytoreduction, 25 thrombotic and 17 bleeding episodes were recorded. In CALR-mutated patients, antiplatelet therapy did not affect the risk of thrombosis but was associated with a higher incidence of bleeding (12.9 versus 1.8 episodes per 1000 patient-years, P=0.03). In JAK2(V617F)-mutated patients, low-dose aspirin was associated with a reduced incidence of venous thrombosis with no effect on the risk of bleeding. Coexistence of JAK2(V617F)-mutation and cardiovascular risk factors increased the risk of thrombosis, even after adjusting for treatment with low-dose aspirin (incidence rate ratio: 9.8; 95% confidence interval: 2.3-42.3; P=0.02). Time free from cytoreduction was significantly shorter in CALR-mutated patients with essential thrombocythemia than in JAK2(V617F)-mutated ones (median time 5 years and 9.8 years, respectively; P=0.0002) and cytoreduction was usually necessary to control extreme thrombocytosis. In conclusion, in patients with low-risk, CALR-mutated essential thrombocythemia, low-dose aspirin does not reduce the risk of thrombosis and may increase the risk of bleeding.

PMID:
27175028
PMCID:
PMC4967571
DOI:
10.3324/haematol.2016.146654
[Indexed for MEDLINE]
Free PMC Article

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