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Meta-Analysis
. 2019 Feb 28;19(1):184.
doi: 10.1186/s12885-019-5387-9.

A systematic review and meta-analysis of the prevalence of thrombosis and bleeding at diagnosis of Philadelphia-negative myeloproliferative neoplasms

Tarinee Rungjirajittranon  1 , Weerapat Owattanapanich  2 , Patompong Ungprasert  3 , Noppadol Siritanaratkul  4 , Theera Ruchutrakool  4
Affiliations
Meta-Analysis

A systematic review and meta-analysis of the prevalence of thrombosis and bleeding at diagnosis of Philadelphia-negative myeloproliferative neoplasms

Tarinee Rungjirajittranon et al. BMC Cancer. .

Abstract

Background: Philadelphia (Ph) chromosome-negative myeloproliferative neoplasms (MPNs) are a heterogeneous group of hematopoietic stem cell clonal diseases. Most patients with MPN are asymptomatic at diagnosis although some of them suffer from constitutional symptoms. Thrombosis and bleeding can also be one of the initial manifestations although the reported prevalence varied considerably across the studies. This systematic review and meta-analysis was conducted with the aims to better understand the prevalence and characteristics of thrombosis and bleeding among patients with newly-diagnosed MPN.

Methods: Using a search strategy that included the terms for myeloproliferative neoplasms, thrombosis, and bleeding, two investigators independently searched for published articles indexed in the MEDLINE and EMBASE databases from inception to August 2018. The pooled prevalence was calculated using the DerSimonian-Laird random-effects model with a double arcsine transformation.

Results: A total of 29 cohort studies (8 prospective and 21 retrospective) with 13,436 patients with MPN were included into this meta-analysis. At diagnosis, the pooled prevalence of overall thrombosis among patients with MPN was 20.0% (95% CI, 16.6-23.8%; I2 96%), with the pooled prevalence of arterial thrombosis of 16.2% (95% CI, 13.0-20.0%; I2 95%) and the pooled prevalence of venous thrombosis of 6.2% (95% CI, 4.9-7.8%; I2 89%). Common thrombotic events included cerebrovascular disease/transient ischemic attack, coronary heart disease, and deep venous thrombosis. The pooled prevalence of hemorrhagic complications among patients who were newly diagnosed with MPN patients was 6.2% (95% CI, 5.0-7.8%; I2 85%). Common sites of bleeding included gastrointestinal, mucosal, and cutaneous bleeding.

Conclusions: Thrombosis and bleeding are common initial manifestations of MPN. Investigations for MPN should be considered for patients who present with unexplained thrombosis or abnormal bleeding.

Keywords: Bleeding; Essential thrombocythemia; Hemorrhage; Myeloproliferative neoplasms; Polycythemia vera; Prevalence; Primary myelofibrosis; Thrombosis.

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Conflict of interest statement

Ethics approval and consent to participate

The need for ethics approval by an institutional board review was waived as this study does not directly involve human subjects.

Consent for publication

Not applicable because this study does not directly involve human subjects.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of literature review process
Fig. 2
Fig. 2
Forest plot of pooled prevalence and 95% confidence interval of overall thrombosis in patients with MPN
Fig. 3
Fig. 3
Forest plot of pooled prevalence and 95% confidence interval of overall thrombosis of each MPN subtype: a polycythemia vera; (b) essential thrombocythemia; (c) primary myelofibrosis
Fig. 4
Fig. 4
Forest plot of pooled prevalence and 95% confidence interval of (a) arterial thrombosis and (b) venous thrombosis in patients with MPN
Fig. 5
Fig. 5
Forest plot of pooled prevalence and 95% confidence interval of overall bleeding complications in patients with MPN
Fig. 6
Fig. 6
Forest plot of pooled prevalence and 95% confidence interval of overall bleeding complications of each MPN subtype: a primary myelofibrosis; (b) essential thrombocythemia; (c) polycythemia vera
See this image and copyright information in PMC

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