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Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German
A Kaifie1, M Kirschner1, D Wolf2
1Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Background:
Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN.
Methods:
The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events.
Results:
MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95% CI = 1.39-8.48) and splenomegaly (OR 1.76; 95% CI = 1.15-2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95% CI = 1.36-5.40), splenomegaly (OR = 2.22; 95% CI 1.01-4.89), and the administration of heparin (OR = 5.64; 95% CI = 1.84-17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups.
Conclusions:
Together, this report on an unselected "real-world" cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.
Insights
Patients with myeloproliferative neoplasms (MPN) face high risks of thrombosis and bleeding. This study identifies key risk factors for these events in a real-world cohort, informing better management strategies for MPN patients.
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Patients with Ph-negative myeloproliferative neoplasms (MPN), including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), have an elevated risk of thrombosis and major bleeding.
- Antiplatelet and anticoagulant therapies are frequently used for prophylaxis, but disease-related bleeding complications also occur.
- Understanding the frequency and risk factors for these vascular events is crucial for patient management.
Purpose of the Study:
- To determine the frequency of thromboembolic and major bleeding events in a cohort of MPN patients.
- To identify risk factors associated with these complications.
- To assess the role and impact of antiplatelet/anticoagulant therapy in MPN patients.
Main Methods:
- Analysis of data from the MPN registry of the Study Alliance Leukemia, a non-interventional prospective study.
- Inclusion of adult patients diagnosed with MPN according to WHO criteria (2008).
- Utilized descriptive statistics and contingency tables to identify risk factors for vascular events.
Main Results:
- Significant differences in demographic and clinical characteristics were observed across MPN subgroups.
- Thromboembolic events were common around diagnosis, with one-third occurring subsequently. Post-PV-MF and MPN-U patients had higher risks of splanchnic vein thrombosis.
- Risk factors for thromboembolism included post-PV-MF and splenomegaly. Major bleeding risks were associated with prior thromboembolic events, splenomegaly, and heparin administration. ET patients had fewer major bleeding episodes.
Conclusions:
- This study provides real-world data on the prevalence and management of thromboembolic and bleeding complications in an unselected German MPN patient cohort.
- Findings highlight specific risk factors for vascular events and bleeding in different MPN subtypes.
- The data contributes to a better understanding of MPN complications and informs clinical practice.
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