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Are MPNs vascular diseases?

Guido Finazzi1, Valerio De Stefano, Tiziano Barbui

  • 1Division of Hematology, Ospedale Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, BG, Italy, gfinazzi@hpg23.it.

Current Hematologic Malignancy Reports
|September 17, 2013
PubMed

Insights

Myeloproliferative neoplasms (MPNs) like polycythemia vera (PV) and essential thrombocythemia (ET) significantly increase thrombosis risk. Management involves anticoagulants, aspirin, phlebotomy, and myelosuppressive agents to reduce vascular complications.

Area of Science:

  • Hematology
  • Oncology
  • Vascular Medicine

Background:

  • Chronic myeloproliferative neoplasms (MPNs), including polycythemia vera (PV) and essential thrombocythemia (ET), are characterized by a high risk of arterial and venous thrombosis.
  • Thrombosis in MPNs shares clinical and pathogenetic features with other vascular diseases, including inherited thrombophilias and atherosclerosis.

Purpose of the Study:

  • To review the clinical aspects, pathogenesis, and management of thrombosis in MPNs.
  • To highlight the commonalities between MPN-associated thrombosis and other vascular pathologies.
  • To discuss current therapeutic strategies for reducing thrombosis in MPNs.

Main Methods:

  • Literature review and synthesis of existing research on MPN-associated thrombosis.
  • Comparison of MPN thrombosis with inherited thrombophilias, atherosclerosis, and thrombosis in solid cancers.
  • Analysis of therapeutic options including anticoagulants, aspirin, phlebotomy, and myelosuppressive agents.

Main Results:

  • MPN-associated thrombosis involves atypical venous sites and acquired resistance to activated protein C, linking it to inherited thrombophilia.
  • Leukocyte and inflammation roles, along with high mortality from arterial occlusions, connect MPNs to atherosclerosis.
  • Aspirin has proven efficacy in reducing thrombosis and mortality in PV.
  • Virchow's triad (impaired blood cells, endothelium, blood flow) is relevant to both MPNs and thrombosis in cancer.

Conclusions:

  • Anticoagulants are primary for managing thrombotic complications in MPNs.
  • Aspirin is effective for reducing thrombosis and mortality in PV.
  • Phlebotomy and myelosuppressive agents are key therapies for correcting underlying abnormalities and preventing thrombosis in MPNs.

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