A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms

Blood Advances - Tập 5 - Trang 113-121 - 2021
Eva N. Hamulyák1, Joost G. Daams2, Frank W.G. Leebeek3, Bart J. Biemond4, Peter A.W. te Boekhorst3, Saskia Middeldorp1, Mandy N. Lauw1,3,4
1Department of Vascular Medicine and Amsterdam, The Netherlands
2Medical Library, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands;
3Department of Hematology, Erasmus University Medical Center (Erasmus MC) Rotterdam, Rotterdam, The Netherlands
4Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

Tóm tắt

Abstract Patients with myeloproliferative neoplasms (MPNs), polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have an increased risk of thrombosis. Risk of recurrent thrombosis can be reduced with antithrombotic therapy and/or cytoreduction, but the optimal long-term management in patients with MPN with a history of venous thromboembolism (VTE) is unknown, and clinical practice is heterogeneous. We performed a systematic review and meta-analysis of randomized trials and observational studies evaluating anticoagulant and/or antiplatelet therapy, with or without cytoreduction, in MPN patients with a history of VTE. A total of 5675 unique citations were screened for eligibility. No randomized trials were identified. Ten observational studies involving 1295 patients with MPN were included in the analysis. Overall, 23% had an arterial or recurrent venous thrombotic event on follow-up. The recurrence risk was lowest for patients on oral anticoagulation plus cytoreduction (16%); 55 of 313 (18%) with vitamin K antagonists (VKA) and 5 of 63 (8%) with direct oral anticoagulants (DOACs). In 746 analyzed patients, the risk of recurrent VTE ranged up to 33% (median 13%) and was low in 63 DOAC plus cytoreduction-treated patients (3.2%). All types of antithrombotic treatments were associated with a lower risk of recurrent VTE when combined with cytoreduction. Most studies had a high risk of bias, whereas clinical and statistical heterogeneity led to inconsistent and imprecise findings. In summary, evidence on the optimal antithrombotic treatment of VTE in patients with MPN is based on observational studies only with low certainty for all strategies. Our data suggest that a combination of anticoagulation and cytoreduction may provide the lowest recurrence risk.

Tài liệu tham khảo

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Blood Advances

Tập 5

113-121

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