Risk factors for arterial versus venous thrombosis in polycythemia vera: a single center experience in 587 patients

Abstract

In a recent International Working Group on Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) study, prior arterial events and hypertension were predictors of subsequent arterial thrombosis whereas prior venous events and age ≥65 years predicted venous thrombosis in polycythemia vera (PV). In the current study, we sought to validate the above findings and identify additional predictors of arterial versus venous thrombosis. At a median follow up of 109 months, thrombosis after diagnosis occurred in 128 (22%) patients; 82 (14%) arterial and 57 (10%) venous events. On multivariate analysis, prior arterial events (<0.0001), hyperlipidemia (p = 0.03), and hypertension (p = 0.02) predicted subsequent arterial events. In comparison, prior venous events (p = 0.05), leukocytosis ≥11 × 109/L (p = 0.002), and major hemorrhage (p = 0.02) were predictors of subsequent venous events. Salient associations with arterial thrombosis included age ≥ 60 years, hypertension, diabetes, hyperlipidemia and normal karyotype whereas age ≤ 60 years, females, palpable splenomegaly and history of major hemorrhage were associated with venous thrombosis. TET2 or ASXL1 mutations did not impact arterial nor venous thrombosis. In conclusion, we identify distinct associations for arterial versus venous thrombosis in PV and confirm that a prior arterial or venous thrombotic event is the most reliable predictor of subsequent events.

A guideline for the diagnosis and management of polycythaemia vera. A British Society for Haematology Guideline

“…There is considerable published evidence of an association between increased WBC count and thrombosis risk in PV (Barbui et al , ; Caramazza et al , ) ((De Stefano et al , ; Barbui et al , ) (Cerquozzi et al , ). In contrast, one prospective study did not find such an association (Passamonti et al , ).…”

“…Abnormal karyotype and other molecular abnormalities (e.g. TET2 mutations) have been reported in PV and some may have prognostic value (Delic et al, 2016;Cerquozzi et al, 2017) but these tests are not routinely required at diagnosis.…”

Elevated White Blood Cell Levels and Thrombotic Events in Patients With Polycythemia Vera: A Real-World Analysis of Veterans Health Administration Data

“…11 Â10 9 /L (hazard ratio, 1.3; 95% CI, 0.9-2.0; P ¼ .03) were associated with an increased risk of future TEs. 5 In the ECLAP study, a significant risk of major thrombosis was observed with a WBC count > 15 Â10 9 /L compared with a WBC count of 10 Â10 9 /L (hazard ratio, 1.71; 95% CI, 1.10-2.65; P ¼ .017). 3 These findings suggest that control of the WBC count should be an important consideration in the disease management in PV.…”

Aquagenic pruritus in essential thrombocythemia is associated with a higher risk of thrombosis

“…Arterial or venous thromboses are the most frequent complications in ET. Multiple risk factors of thrombosis including age, history of thrombosis, cardiovascular risks (eg, diabetes, hypertension, tobacco smoking), leucocytosis, the presence of JAK2V617F mutation and its allele burden have been recently identified …”

“…Multiple risk factors of thrombosis including age, history of thrombosis, cardiovascular risks (eg, diabetes, hypertension, tobacco smoking), leucocytosis, the presence of JAK2V617F mutation and its allele burden have been recently identified. 1,2 Even though approximately 50% of newly diagnosed ET patients are asymptomatic, some symptoms such as pruritus are commonly reported. We recently reported that like polycythemia vera (PV) patients, ET patients suffer from aquagenic pruritus (AP), an annoying pruritus that arises after contact with water and demonstrated some interesting clinical differences between MPN subtypes, particularly between PV and ET as the influence of water temperature, the duration and location of crises, and the influence of cytoreductive treatments.…”