High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists

V. de Stefano, M. Ruggeri, F. Cervantes, A. Alvarez-Larrán, A. Iurlo, M. L. Randi, E. Elli, M. C. Finazzi, G. Finazzi, E. Zetterberg, N. Vianelli, G. Gaidano, E. Rossi, S. Betti, I. Nichele, D. Cattaneo, M. Palova, M. H. Ellis, R. Cacciola, A. TieghiJ. C. Hernandez-Boluda, E. Pungolino, G. Specchia, D. Rapezzi, A. Forcina, C. Musolino, A. Carobbio, M. Griesshammer, E. Sant’Antonio, A. M. Vannucchi, T. Barbui

Research output: Contribution to journalArticle

Abstract

The optimal duration of treatment with vitamin K antagonists (VKA) after venous thromboembolism (VTE) in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) is uncertain. To tackle this issue, we retrospectively studied 206 patients with MPN-related VTE (deep venous thrombosis of the legs and/or pulmonary embolism). After this index event, we recorded over 695 pt-years 45 recurrences, venous in 36 cases, with an incidence rate (IR) of 6.5 per 100 pt-years (95% confidence interval (CI): 4.9–8.6). One hundred fifty-five patients received VKA; the IR of recurrent thrombosis per 100 pt-years was 4.7 (95% CI: 2.8–7.3) on VKA and 8.9 (95% CI: 5.7–13.2) off VKA (P=0.03). In patients receiving VKA, the IR of recurrent thrombosis per 100 pt-years was 5.3 (95% CI: 3.2–8.4) among 108 patients on long-term VKA and 12.8 (95% CI: 7.3–20.7) after discontinuation among the 47 who ceased treatment (P=0.008), with a doubled risk of recurrence after stopping VKA (hazard ratio: 2.21, 95% CI: 1.19–5.30). The IR of major bleeding per 100 pt-years was 2.4 (95%: CI: 1.1–4.5) on VKA and 0.7 (95% CI: 0.08–2.5) off VKA (P=0.08). In conclusion, in MPN patients with VTE recurrent thrombosis is significantly reduced by VKA and caution should be adopted in discontinuation; however, the incidence of recurrence on treatment remains high, calling for clinical trials aimed to improve prophylaxis in this setting.Leukemia advance online publication, 13 May 2016; doi:10.1038/leu.2016.85.

Original languageEnglish
Pages (from-to)2032-2038
Number of pages7
JournalLeukemia
Volume30
Issue number10
DOIs
Publication statusPublished - 2016

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ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

de Stefano, V., Ruggeri, M., Cervantes, F., Alvarez-Larrán, A., Iurlo, A., Randi, M. L., Elli, E., Finazzi, M. C., Finazzi, G., Zetterberg, E., Vianelli, N., Gaidano, G., Rossi, E., Betti, S., Nichele, I., Cattaneo, D., Palova, M., Ellis, M. H., Cacciola, R., ... Barbui, T. (2016). High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists. Leukemia, 30(10), 2032-2038. https://doi.org/10.1038/leu.2016.85