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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-Larran, A.; Iurlo, A.; Randi, M. L.; Elli, E.; Finazzi, M. C.; Finazzi, G. and Zetterberg, E. LU , et al. (2016) In Leukemia 30(10). p.2032-2038
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... (More)

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.

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Leukemia
volume
30
issue
10
pages
7 pages
publisher
Nature Publishing Group
external identifiers
  • scopus:84966559653
  • wos:000385801500010
ISSN
0887-6924
DOI
10.1038/leu.2016.85
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English
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yes
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dcc01f4e-f69d-4160-b647-428b2ceaa8df
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2016-12-08 14:06:50
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2017-11-16 15:07:39
@article{dcc01f4e-f69d-4160-b647-428b2ceaa8df,
  abstract     = {<p>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.</p>},
  author       = {De Stefano, V. and Ruggeri, M. and Cervantes, F. and Alvarez-Larran, A. and Iurlo, A. and Randi, M. L. and Elli, E. and Finazzi, M. C. and Finazzi, G. and Zetterberg, E. and Vianelli, N. and Gaidano, G. and Rossi, E. and Betti, S. and Nichele, I. and Cattaneo, D. and Palova, M. and Ellis, M. H. and Cacciola, R. and Tieghi, A. and Hernandez-Boluda, J. C. and Pungolino, E. and Specchia, G. and Rapezzi, D. and Forcina, A. and Musolino, C. and Carobbio, A. and Griesshammer, M. and Sant'Antonio, E. and Vannucchi, A. M. and Barbui, T.},
  issn         = {0887-6924},
  language     = {eng},
  month        = {10},
  number       = {10},
  pages        = {2032--2038},
  publisher    = {Nature Publishing Group},
  series       = {Leukemia},
  title        = {High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with Vitamin K antagonists},
  url          = {http://dx.doi.org/10.1038/leu.2016.85},
  volume       = {30},
  year         = {2016},
}