Global coagulation in myeloproliferative neoplasms

Armando Tripodi, Veena Chantarangkul, Francesca Gianniello, Marigrazia Clerici, Laura Lemma, Lidia Padovan, Loredana Gatti, Pier Mannuccio Mannucci, Flora Peyvandi

Research output: Contribution to journalArticle

Abstract

In spite of their recognized risk of thrombosis, patients with myeloproliferative neoplasms (MPN) show little or no abnormalities of traditional coagulation tests, perhaps because these are unable to represent the balance between pro- and anticoagulants nor the effect of platelets and blood cells. We investigated whether global tests such as thrombin generation in platelet-rich plasma (PRP) or thromboelastometry in whole blood were able to detect signs of procoagulant imbalance in MPN. The endogenous thrombin potential (ETP) of 111 patients and 89 controls was measured in PRP with platelet count adjusted to the original patient- or control-count. Testing was performed with and without thrombomodulin (the physiological protein C activator) and results were expressed as ETP ratios (with/without thrombomodulin). High ETP ratios reflect resistance to thrombomodulin and were taken as indexes of procoagulant imbalance. Patients were also investigated by thromboelastometry that provides such parameters as the clot formation time (CFT) and maximal clot firmness (MCF). Short CFT or high MCF were taken as indexes of procoagulant imbalance. ETP ratios were higher in patients than in controls and were directly correlated with platelet counts and inversely with the plasma levels of free protein S, protein C and antithrombin. Patients on hydroxyurea had lower ETP ratios than those on other treatments. CFT was shorter and MCF was greater in patients than controls; CFT and MCF were correlated with platelet counts. In conclusion, patients with MPN display a procoagulant imbalance detectable by thrombin generation and thromboelastometry. These tests might be useful in the frame of clinical trials to assess their association with the occurrence of thrombosis and with the effect of therapeutic strategies in MPN.

Original languageEnglish
Pages (from-to)1633-1639
Number of pages7
JournalAnnals of Hematology
Volume92
Issue number12
DOIs
Publication statusPublished - Dec 2013

Keywords

  • Essential thrombocythemia
  • Polycythemia vera
  • Thrombin generation
  • Thromboelastometry
  • Thrombosis

ASJC Scopus subject areas

  • Hematology

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