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. 2016 Mar 5:9:18.
doi: 10.1186/s13045-016-0242-9.

Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry

A Kaifie  1 , M Kirschner  1 , D Wolf  2 , C Maintz  3 , M Hänel  4 , N Gattermann  5 , E Gökkurt  6 , U Platzbecker  7 , W Hollburg  8 , J R Göthert  9 , S Parmentier  10 , F Lang  11 , R Hansen  12 , S Isfort  1 , K Schmitt  1 , E Jost  1 , H Serve  11 , G Ehninger  7 , W E Berdel  13 , T H Brümmendorf  1 , S Koschmieder  14 ; Study Alliance Leukemia (SAL)
Affiliations

Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry

A Kaifie et al. J Hematol Oncol. .

Abstract

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.

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Figures

Fig. 1
Fig. 1
Distribution of the MPN subtypes in the registry (n = 466). Classical MPN, PV, ET, and PMF represent 85 % of all subtypes, followed by post-PV and post-ET myelofibrosis and MPN-U. Documentation of CNL, HES/CEL, SM, and MPN with a PDGFR-alpha, PDGFR-beta, or FGFR1-aberration was infrequent (together 2.4 % of all subtypes)
Fig. 2
Fig. 2
Number of thrombotic/thromboembolic (a) and major bleeding events (b) in MPN over time in months. The 0 (zero) marks the date of diagnosis. In a (thrombotic and thromboembolic events), there are several events before and after diagnosis which presents almost like a normal distribution. While in b (bleedings events), there were only two cases of major bleedings described before date of diagnosis—all other major bleedings occurred after that date
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