Document Detail

Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: incidence, risk factors, and effect of treatments.
MedLine Citation:
PMID:  18268279     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Prior thrombosis is a well-established risk factor for re-thrombosis in polycythemia vera and essential thrombocythemia but scarce data are available on the rate of re-thrombosis and the optimal strategy for prevention of recurrence. DESIGN AND METHODS: We retrospectively estimated the rate of recurrence in a multicenter cohort of 494 patients (poly-cythemia vera/essential thrombocythemia 235/259) with previous arterial (67.6%) or venous thrombosis (31%) or both (1.4%). First thrombosis was cerebrovascular disease in 191 cases, acute coronary syndrome in 106, peripheral arterial thrombosis in 44, and venous thromboembolism in 160. Microcirculatory events were not computed. RESULTS: Thrombosis recurred in 166 patients (33.6%), with an incidence of 7.6% patient-years. Sex, diagnosis (polycythemia vera or essential thrombocythemia), and presence of vascular risk factors did not predict recurrence, whereas age >60 years did (multivariable hazard ratio [HR], 1.67; 95% confidence interval [CI] 1.19-2.32). Increased leukocyte count at the time of the first thrombosis was a risk factor for recurrence in patients <60 years old (HR 3.55; 95% CI 1.02-12.25). Cytoreduction halved the risk in the overall cohort (HR 0.53; 95% CI 0.38-0.73) and the combination with antiplatelet agents or oral anticoagulants was more effective than administration of single drugs. Significant prevention of rethrombosis was independently achieved in patients with venous thromboembolism by both oral anticoagulants (HR 0.32; 95% CI 0.15-0.64) and antiplatelet agents (HR 0.42; 95% CI 0.22-0.77), in those with acute coronary syndrome by cytoreduction (HR 0.30; 95% CI 0.13-0.68), and in those with cerebrovascular disease by antiplatelet agents (HR 0.33; 95% CI 0.16-0.66). The overall incidence of major bleeding was 0.9% patient-years and rose to 2.8% in patients receiving both antiplatelet and anti-vitamin K agents. CONCLUSIONS: In patients with polycythemia vera and essential thrombocythemia, cytoreduction protects against recurrent thrombosis, particularly after acute coronary syndrome. The contemporary use of oral anticoagulants (after venous thromboembolism) or antiplatelet agents (after cerebrovascular disease or venous thromboembolism) further improves the protective effect. Such findings call for prospective studies aimed at investigating whether strategies tailored according to the type of first thrombosis could improve prevention of recurrences.
Valerio De Stefano; Tommaso Za; Elena Rossi; Alessandro M Vannucchi; Marco Ruggeri; Elena Elli; Caterina Micò; Alessia Tieghi; Rossella R Cacciola; Cristina Santoro; Giancarla Gerli; Nicola Vianelli; Paola Guglielmelli; Lisa Pieri; Francesca Scognamiglio; Francesco Rodeghiero; Enrico M Pogliani; Guido Finazzi; Luigi Gugliotta; Roberto Marchioli; Giuseppe Leone; Tiziano Barbui;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2008-02-11
Journal Detail:
Title:  Haematologica     Volume:  93     ISSN:  1592-8721     ISO Abbreviation:  Haematologica     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-07-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0417435     Medline TA:  Haematologica     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  372-80     Citation Subset:  IM    
Institute of Hematology, Catholic University, Largo Gemelli 8, 00168 Rome, Italy.
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MeSH Terms
Acute Coronary Syndrome / epidemiology,  etiology
Aged, 80 and over
Anticoagulants / adverse effects,  therapeutic use
Arterial Occlusive Diseases / epidemiology,  etiology
Follow-Up Studies
Hemorrhage / chemically induced
Middle Aged
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use
Polycythemia Vera / blood,  complications*,  therapy
Retrospective Studies
Risk Factors
Stroke / epidemiology,  etiology
Thrombocythemia, Essential / blood,  complications*,  therapy
Thrombophilia / etiology,  genetics
Thrombosis / epidemiology,  etiology*,  prevention & control
Venous Thrombosis / epidemiology,  etiology
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors
Comment In:
Haematologica. 2008 Mar;93(3):331-5   [PMID:  18310537 ]

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