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

V. De Stefano, A. Carobbio, V. Di Lazzaro, P. Guglielmelli, A. Iurlo, M.C. Finazzi, E. Rumi, F. Cervantes, E.M. Elli, M.L. Randi, M. Griesshammer, F. Palandri, M. Bonifacio, J.-C. Hernandez-Boluda, R. Cacciola, P. Miroslava, G. Carli, E. Beggiato, M.H. Ellis, C. MusolinoG. Gaidano, D. Rapezzi, A. Tieghi, F. Lunghi, G.G. Loscocco, D. Cattaneo, A. Cortelezzi, S. Betti, E. Rossi, G. Finazzi, B. Censori, M. Cazzola, M. Bellini, E. Arellano-Rodrigo, I. Bertozzi, P. Sadjadian, N. Vianelli, L. Scaffidi, M. Gomez, E. Cacciola, A.M. Vannucchi, T. Barbui

Research output: Contribution to journalArticlepeer-review

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. © 2018 The Author(s).
Original languageEnglish
JournalBlood Cancer Journal
Volume8
Issue number3
DOIs
Publication statusPublished - 2018

Keywords

  • acetylsalicylic acid
  • anagrelide
  • anticoagulant agent
  • antithrombocytic agent
  • antivitamin K
  • busulfan
  • calretinin
  • heparin
  • hydroxyurea
  • interferon
  • Janus kinase 2
  • pipobroman
  • ruxolitinib
  • thrombopoietin receptor
  • antineoplastic agent
  • fibrinolytic agent, acute heart infarction
  • adult
  • age
  • aged
  • anticoagulant therapy
  • artery thrombosis
  • Article
  • bladder cancer
  • brain hemorrhage
  • brain ischemia
  • brain vein
  • breast cancer
  • cardiovascular infection
  • cardiovascular mortality
  • cardiovascular risk
  • chronic lymphatic leukemia
  • clinical feature
  • clinical outcome
  • cohort analysis
  • digestive system cancer
  • drug efficacy
  • drug safety
  • epistaxis
  • female
  • gastrointestinal hemorrhage
  • gene mutation
  • human
  • hypertension
  • kidney cancer
  • liver cancer
  • liver vein thrombosis
  • long term care
  • low drug dose
  • lung cancer
  • lung embolism
  • major clinical study
  • male
  • microangiopathy
  • muscle hematoma
  • myeloproliferative neoplasm
  • peripheral vein
  • phlebotomy
  • polycythemia vera
  • prostate cancer
  • recurrence risk
  • retina vein
  • retrospective study
  • risk assessment
  • risk benefit analysis
  • skin cancer
  • spleen infarction
  • thrombocythemia
  • thrombophilia
  • transient ischemic attack
  • unstable angina pectoris
  • vein thrombosis
  • cerebrovascular accident
  • clinical trial
  • disease free survival
  • hematologic disease
  • middle aged
  • mortality
  • multicenter study
  • myeloproliferative disorder
  • risk factor
  • survival rate
  • very elderly, Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Brain Ischemia
  • Disease-Free Survival
  • Female
  • Fibrinolytic Agents
  • Hematologic Neoplasms
  • Humans
  • Male
  • Middle Aged
  • Myeloproliferative Disorders
  • Platelet Aggregation Inhibitors
  • Retrospective Studies
  • Risk Factors
  • Stroke
  • Survival Rate

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