Myocardial infarction as a thrombotic complication of essential thrombocythemia and polycythemia vera

Abstract

Objective:Detailed analyses of clinical characteristics of myocardial infarction (MI) as an essential thrombocythemia (ET)- and polycythemia vera (PV)-related complication have been so far presented mostly as case reports. Therefore, the aim of this retrospective analysis was to evaluate the main cardiological and hematological characteristics for better understanding myocardial complications in ET/PV.Methods:A retrospective analysis was carried out involving 263 patients diagnosed with ET or PV (155/108) between 1998 and 2014. Fourteen patients suffered MI during the hematological follow-up. Their clinical characteristics were compared to 162 patients (97 ET and 65 PV patients) who did not exhibit any major thrombotic complications (MI, stroke/transient ischemic attack, and venous events) before or after hematological diagnosis of ET/PV.Results:Fourteen MI events occurred among the 263 patients (5.3%). Vascular risk factors were found in 92.9% (13/14) of analyzed cases. In all, 71.4% of the MI complications developed within 12 months after the diagnosis of ET/PV. The coronary angiography findings revealed ST-elevation MI in four cases and non-ST-elevation MI in 10. Significant stenosis of coronary arteries requiring percutaneous coronary intervention with a stent implantation was present in seven cases, while three had complex stenoses or previous grafts/stents. All of them had undergone coronary artery bypass graft operations.Conclusion:The results of the present study suggest that early detection and consideration of individual management of vascular risk factors in ET/PV patients are also important. Furthermore, a better theoretic understanding of platelet activation and role of leukocytes in myeloproliferative neoplasm-related thrombosis could open new perspectives in thrombosis prediction and prevention.

Erythrocyte-derived microvesicles induce arterial spasms in JAK2V617F myeloproliferative neoplasm

“…This finding sug-gests a vasospastic phenomenon associated with MPN and thus represents a paradigm shift with regard to MPNs, as arterial events have only been seen to be a result of a thrombotic process (7). Our results obtained ex vivo and in vivo could explain this higher incidence of arterial events in patients with polycythemia vera than in the general population and the high prevalence of myocardial infarction without significant coronary stenosis by angiography in patients with MPN (8). Arterial spasm is an underdiagnosed phenomenon that can occur in patients without atherosclerosis, but underlying nonstenotic atherosclerotic plaques are also known to be a contributing factor.…”

“…Erythrocyte-derived microvesicles induce arterial spasms in JAK2 V617F myeloproliferative neoplasm Johanne Poisson, 1,2,3 Marion Tanguy, 1,2 Hortense Davy, 1 Fatoumata Camara, 1 Marie-Belle El Mdawar, 1 Marouane Kheloufi, 1 Tracy Dagher, 4 Cécile Devue, 1 Juliette Lasselin, 1 Aurélie Plessier, 5,6 Salma Merchant, 4 Olivier Blanc-Brude, 1 Michèle Souyri, 7 Nathalie Mougenot, 8 Florent Dingli, 9 Damarys Loew, 9 Stephane N. Hatem, 10 Chloé James, 11,12,13 Jean-Luc Villeval, 4 Chantal M. Boulanger, 1 and Pierre-Emmanuel Rautou 1,2,4,5 presence of the Jak2 V617F mutation in hematopoietic, but not endothelial, cells is responsible for the increase in arterial contraction in response to vasoconstrictors we observed in Jak2 V617F HC-EC mice (Figure 1, E-G).…”

The impact of thrombosis and bleeding among patients with Myeloproliferative Neoplasm: Systematic Review and Meta-Analysis

“…Ninety two percent of the investigated cases have vascular risk factors and the complication occur within 12 months after ET and PV diagnosis 34 . The incidence of arterial and venous thrombosis is increasing across in all age groups of MPN patients in comparison with the controls.…”

An Unusual Case of Acute Stent Thrombosis: A Review of a Rare Cause of Acute Stent Occlusion

“…However, in patients with myeloproliferative disorders such as essential thrombocytosis, there is a high predisposition to thrombotic and haemorrhagic events associated with significant morbidity and mortality [4]. This is well documented within case reports within the current literature [5][6][7]. However we are aware that reactive thrombocytosis following myocardial infarction is rare [5,[8][9][10].…”