Splanchnic vein thrombosis in myeloproliferative neoplasms

Treatment algorithm 2018

Guido Finazzi, Valerio De Stefano, Tiziano Barbui

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Myeloproliferative neoplasms (MPNs) are a leading cause of splanchnic vein thrombosis (SVT). SVT is observed in all MPNs and frequently affects young patients. Therapy should be addressed to three main goals: preventing thrombosis recurrence, managing the underlying MPN, and supporting liver dysfunction. Life-long oral anticoagulation with Vitamin K antagonists is the cornerstone of the antithrombotic treatment. However, recurrences of SVT or other thrombosis may occur in 15-20% of patients. Direct oral anticoagulants can represent an alternative and preliminary data encourage comparative studies. Survival of patients with SVT in MPN is primarily influenced by the natural history of the underlying neoplasms, rather than the SVT event. An aggressive management is recommended and a treatment algorithm based on the different MPN subtypes is proposed. Hydroxyurea is the cytoreductive drug of choice in polycythemia vera and essential thrombocythemia, whereas ruxolitinib is indicated in intermediate and high-risk patients with myelofibrosis and in PV patients resistant or intolerant to hydroxyurea. The management of SVT in MPNs requires a multidisciplinary approach that may include a hematologist, a gastroenterologist, an interventional radiologist, and a surgeon. In the case of clinical deterioration despite pharmacological therapy, patients with SVT should be considered for invasive procedures or liver transplantation.

Original languageEnglish
JournalBlood Cancer Journal
Volume8
Issue number7
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

Viscera
Veins
Thrombosis
Neoplasms
Therapeutics
Hydroxyurea
Essential Thrombocythemia
Recurrence
Polycythemia Vera
Primary Myelofibrosis
Vitamin K
Liver Transplantation
Anticoagulants
Liver Diseases
Pharmacology
Survival

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Splanchnic vein thrombosis in myeloproliferative neoplasms : Treatment algorithm 2018. / Finazzi, Guido; De Stefano, Valerio; Barbui, Tiziano.

In: Blood Cancer Journal, Vol. 8, No. 7, 01.07.2018.

Research output: Contribution to journalArticle

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