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

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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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Vitamin K
Venous Thromboembolism
Confidence Intervals
Neoplasms
Incidence
Thrombosis
Recurrence
Pulmonary Embolism
Venous Thrombosis
Publications
Leg
Leukemia
Therapeutics
Clinical Trials
Hemorrhage

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

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High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists. / 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.; Tieghi, A.; Hernandez-Boluda, J. C.; Pungolino, E.; Specchia, G.; Rapezzi, D.; Forcina, A.; Musolino, C.; Carobbio, A.; Griesshammer, M.; Sant’Antonio, E.; Vannucchi, A. M.; Barbui, T.

In: Leukemia, Vol. 30, No. 10, 2016, p. 2032-2038.

Research output: Contribution to journalArticle

de Stefano, V, Ruggeri, M, Cervantes, F, Alvarez-Larrán, A, Iurlo, A, Randi, ML, Elli, E, Finazzi, MC, Finazzi, G, Zetterberg, E, Vianelli, N, Gaidano, G, Rossi, E, Betti, S, Nichele, I, Cattaneo, D, Palova, M, Ellis, MH, Cacciola, R, Tieghi, A, Hernandez-Boluda, JC, Pungolino, E, Specchia, G, Rapezzi, D, Forcina, A, Musolino, C, Carobbio, A, Griesshammer, M, Sant’Antonio, E, Vannucchi, AM & Barbui, T 2016, 'High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists', Leukemia, vol. 30, no. 10, pp. 2032-2038. https://doi.org/10.1038/leu.2016.85
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. ; Tieghi, A. ; Hernandez-Boluda, J. C. ; Pungolino, E. ; Specchia, G. ; Rapezzi, D. ; Forcina, A. ; Musolino, C. ; Carobbio, A. ; Griesshammer, M. ; Sant’Antonio, E. ; Vannucchi, A. M. ; Barbui, T. / High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists. In: Leukemia. 2016 ; Vol. 30, No. 10. pp. 2032-2038.
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title = "High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists",
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.",
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T1 - High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists

AU - de Stefano, V.

AU - Ruggeri, M.

AU - Cervantes, F.

AU - Alvarez-Larrán, A.

AU - Iurlo, A.

AU - Randi, M. L.

AU - Elli, E.

AU - Finazzi, M. C.

AU - Finazzi, G.

AU - Zetterberg, E.

AU - Vianelli, N.

AU - Gaidano, G.

AU - Rossi, E.

AU - Betti, S.

AU - Nichele, I.

AU - Cattaneo, D.

AU - Palova, M.

AU - Ellis, M. H.

AU - Cacciola, R.

AU - Tieghi, A.

AU - Hernandez-Boluda, J. C.

AU - Pungolino, E.

AU - Specchia, G.

AU - Rapezzi, D.

AU - Forcina, A.

AU - Musolino, C.

AU - Carobbio, A.

AU - Griesshammer, M.

AU - Sant’Antonio, E.

AU - Vannucchi, A. M.

AU - Barbui, T.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

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