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Incidence and impact of atrial arrhythmias on thrombotic events in MPNs

Kristell Mahé1, Aurélien Delluc2,3, Aurélie Chauveau4

  • 1Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, Hôpital Morvan, CHRU de Brest, Avenue Foch, 29609, Brest Cedex, France.

Annals of Hematology
|November 23, 2017
PubMed

Insights

Atrial arrhythmias (AA) significantly increase thrombosis risk in patients with essential thrombocythemia (ET) or polycythemia vera (PV). Careful management of anticoagulants like low-dose aspirin (LDA), vitamin K antagonists (VKA), or direct oral anticoagulants (DOAC) is crucial.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Atrial arrhythmias (AA) are associated with increased thrombotic events, necessitating anticoagulation with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC).
  • Essential thrombocythemia (ET) and polycythemia vera (PV) are myeloproliferative neoplasms (MPN) that also carry a high risk of thrombosis, typically managed with cytoreductive therapy and low-dose aspirin (LDA).

Purpose of the Study:

  • To investigate the incidence and complications of atrial arrhythmias (AA) in patients diagnosed with essential thrombocythemia (ET) or polycythemia vera (PV).
  • To evaluate the impact of AA on thrombotic risk and survival in patients with ET or PV.
  • To assess the effectiveness and safety of current antithrombotic strategies in this patient population.

Main Methods:

  • A case-control study was conducted involving 713 patients with ET or PV.
  • Identified 96 patients (13.5%) with co-existing atrial arrhythmias (AA).
  • Compared demographic data, cardiovascular risk factors, thrombosis history, and survival outcomes between patients with and without AA.

Main Results:

  • Patients with AA were older (median 72.1 vs. 61.3 years) and had more cardiovascular risk factors (80% vs. 61%).
  • A significantly higher incidence of thrombosis was observed before (27.1% vs. 14.6%) and after (35% vs. 18.8%) MPN diagnosis in patients with AA.
  • Thrombosis-free survival was shorter in patients with AA (11.0 vs. 21.6 years), with LDA use associated with increased thrombotic events and VKA showing limited benefit.

Conclusions:

  • The co-occurrence of atrial arrhythmias (AA) and myeloproliferative neoplasms (MPN) like ET and PV is more frequent than anticipated.
  • Atrial arrhythmias (AA) significantly elevate the thrombotic risk in patients with ET or PV.
  • Optimal anticoagulation strategies, potentially involving DOACs or combined therapies, require careful consideration and collaboration between cardiologists and hematologists to mitigate thrombotic events in this high-risk group.

Keywords:
Atrial arrhythmiasEssential thrombocythemiaPolycythemia veraThrombosisVitamin K antagonists

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