Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19

Tiziano Barbui, Valerio De Stefano, Alberto Alvarez-Larran, Alessandra Iurlo, Arianna Masciulli, Alessandra Carobbio, Arianna Ghirardi, Alberto Ferrari, Valeria Cancelli, Elena Maria Elli, Marcio Miguel Andrade-Campos, Mercedes Gasior Kabat, Jean Jaques Kiladjian, Francesca Palandri, Giulia Benevolo, Valentin Garcia-Gutierrez, Maria Laura Fox, Maria Angeles Foncillas, Carmen Montoya Morcillo, Elisa RumiSantiago Osorio, Petros Papadopoulos, Massimiliano Bonifacio, Keina Susana Quiroz Cervantes, Miguel Sagues Serrano, Gonzalo Carreno-Tarragona, Marta Anna Sobas, Francesca Lunghi, Andrea Patriarca, Begoña Navas Elorza, Anna Angona, Elena Magro Mazo, Steffen Koschmieder, Giuseppe Carli, Beatriz Cuevas, Juan Carlos Hernandez-Boluda, Emma Lopez Abadia, Blanca Xicoy Cirici, Paola Guglielmelli, Marta Garrote, Daniele Cattaneo, Rosa Daffini, Fabrizio Cavalca, Beatriz Bellosillo, Lina Benajiba, Natalia Curto-Garcia, Marta Bellini, Silvia Betti, Claire Harrison, Alessandro Rambaldi

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In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (−23.3%, p < 0.0001) than in PV (−16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.

Original languageEnglish
Article number21
JournalBlood Cancer Journal
Issue number2
Publication statusPublished - Feb 2021

ASJC Scopus subject areas

  • Hematology
  • Oncology


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