Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms

Valerio De Stefano, Alessandra Carobbio, Vincenzo Di Lazzaro, Paola Guglielmelli, Alessandra Iurlo, Maria Chiara Finazzi, Elisa Rumi, Francisco Cervantes, Elena Maria Elli, Maria Luigia Randi, Martin Griesshammer, Francesca Palandri, Massimiliano Bonifacio, Juan Carlos Hernandez-Boluda, Rossella Cacciola, Palova Miroslava, Giuseppe Carli, Eloise Beggiato, Martin H. Ellis, Caterina MusolinoGianluca Gaidano, Davide Rapezzi, Alessia Tieghi, Francesca Lunghi, Giuseppe Gaetano Loscocco, Daniele Cattaneo, Agostino Cortelezzi, Silvia Betti, Elena Rossi, Guido Finazzi, Bruno Censori, Mario Cazzola, Marta Bellini, Eduardo Arellano-Rodrigo, Irene Bertozzi, Parvis Sadjadian, Nicola Vianelli, Luigi Scaffidi, Montse Gomez, Emma Cacciola, Alessandro M. Vannucchi, Tiziano Barbui

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.

Original languageEnglish
Article number25
JournalBlood Cancer Journal
Volume8
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Transient Ischemic Attack
Stroke
Pharmaceutical Preparations
Neoplasms
Population
Therapeutics
Anticoagulants
Aspirin
Myocardial Infarction
Hemorrhage
Hypertension
Mortality
Incidence

ASJC Scopus subject areas

  • Hematology
  • Oncology

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Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms. / De Stefano, Valerio; Carobbio, Alessandra; Di Lazzaro, Vincenzo; Guglielmelli, Paola; Iurlo, Alessandra; Finazzi, Maria Chiara; Rumi, Elisa; Cervantes, Francisco; Elli, Elena Maria; Randi, Maria Luigia; Griesshammer, Martin; Palandri, Francesca; Bonifacio, Massimiliano; Hernandez-Boluda, Juan Carlos; Cacciola, Rossella; Miroslava, Palova; Carli, Giuseppe; Beggiato, Eloise; Ellis, Martin H.; Musolino, Caterina; Gaidano, Gianluca; Rapezzi, Davide; Tieghi, Alessia; Lunghi, Francesca; Loscocco, Giuseppe Gaetano; Cattaneo, Daniele; Cortelezzi, Agostino; Betti, Silvia; Rossi, Elena; Finazzi, Guido; Censori, Bruno; Cazzola, Mario; Bellini, Marta; Arellano-Rodrigo, Eduardo; Bertozzi, Irene; Sadjadian, Parvis; Vianelli, Nicola; Scaffidi, Luigi; Gomez, Montse; Cacciola, Emma; Vannucchi, Alessandro M.; Barbui, Tiziano.

In: Blood Cancer Journal, Vol. 8, No. 3, 25, 01.03.2018.

Research output: Contribution to journalArticle

De Stefano, V, Carobbio, A, Di Lazzaro, V, Guglielmelli, P, Iurlo, A, Finazzi, MC, Rumi, E, Cervantes, F, Elli, EM, Randi, ML, Griesshammer, M, Palandri, F, Bonifacio, M, Hernandez-Boluda, JC, Cacciola, R, Miroslava, P, Carli, G, Beggiato, E, Ellis, MH, Musolino, C, Gaidano, G, Rapezzi, D, Tieghi, A, Lunghi, F, Loscocco, GG, Cattaneo, D, Cortelezzi, A, Betti, S, Rossi, E, Finazzi, G, Censori, B, Cazzola, M, Bellini, M, Arellano-Rodrigo, E, Bertozzi, I, Sadjadian, P, Vianelli, N, Scaffidi, L, Gomez, M, Cacciola, E, Vannucchi, AM & Barbui, T 2018, 'Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms', Blood Cancer Journal, vol. 8, no. 3, 25. https://doi.org/10.1038/s41408-018-0048-9
De Stefano, Valerio ; Carobbio, Alessandra ; Di Lazzaro, Vincenzo ; Guglielmelli, Paola ; Iurlo, Alessandra ; Finazzi, Maria Chiara ; Rumi, Elisa ; Cervantes, Francisco ; Elli, Elena Maria ; Randi, Maria Luigia ; Griesshammer, Martin ; Palandri, Francesca ; Bonifacio, Massimiliano ; Hernandez-Boluda, Juan Carlos ; Cacciola, Rossella ; Miroslava, Palova ; Carli, Giuseppe ; Beggiato, Eloise ; Ellis, Martin H. ; Musolino, Caterina ; Gaidano, Gianluca ; Rapezzi, Davide ; Tieghi, Alessia ; Lunghi, Francesca ; Loscocco, Giuseppe Gaetano ; Cattaneo, Daniele ; Cortelezzi, Agostino ; Betti, Silvia ; Rossi, Elena ; Finazzi, Guido ; Censori, Bruno ; Cazzola, Mario ; Bellini, Marta ; Arellano-Rodrigo, Eduardo ; Bertozzi, Irene ; Sadjadian, Parvis ; Vianelli, Nicola ; Scaffidi, Luigi ; Gomez, Montse ; Cacciola, Emma ; Vannucchi, Alessandro M. ; Barbui, Tiziano. / Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms. In: Blood Cancer Journal. 2018 ; Vol. 8, No. 3.
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abstract = "We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2{\%}, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.",
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AU - De Stefano, Valerio

AU - Carobbio, Alessandra

AU - Di Lazzaro, Vincenzo

AU - Guglielmelli, Paola

AU - Iurlo, Alessandra

AU - Finazzi, Maria Chiara

AU - Rumi, Elisa

AU - Cervantes, Francisco

AU - Elli, Elena Maria

AU - Randi, Maria Luigia

AU - Griesshammer, Martin

AU - Palandri, Francesca

AU - Bonifacio, Massimiliano

AU - Hernandez-Boluda, Juan Carlos

AU - Cacciola, Rossella

AU - Miroslava, Palova

AU - Carli, Giuseppe

AU - Beggiato, Eloise

AU - Ellis, Martin H.

AU - Musolino, Caterina

AU - Gaidano, Gianluca

AU - Rapezzi, Davide

AU - Tieghi, Alessia

AU - Lunghi, Francesca

AU - Loscocco, Giuseppe Gaetano

AU - Cattaneo, Daniele

AU - Cortelezzi, Agostino

AU - Betti, Silvia

AU - Rossi, Elena

AU - Finazzi, Guido

AU - Censori, Bruno

AU - Cazzola, Mario

AU - Bellini, Marta

AU - Arellano-Rodrigo, Eduardo

AU - Bertozzi, Irene

AU - Sadjadian, Parvis

AU - Vianelli, Nicola

AU - Scaffidi, Luigi

AU - Gomez, Montse

AU - Cacciola, Emma

AU - Vannucchi, Alessandro M.

AU - Barbui, Tiziano

PY - 2018/3/1

Y1 - 2018/3/1

N2 - We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.

AB - We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.

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