Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies

Bleeker, Jonathan; Hogan, William J.

doi:10.1155/2011/536062

Cited by 119 publications

(125 citation statements)

References 169 publications

(216 reference statements)

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“…An increased risk of vascular complications over time is the main clinical feature of ET; consequently, the evaluation of the thrombotic risk at diagnosis is the crucial point for treatment decision [3,4].…”

Section: Introductionmentioning

confidence: 99%

Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients

Andriani

Latagliata²,

Anaclerico

et al. 2016

American J Hematol

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Spleen enlargement, present in 10–20% of Essential Thrombocythemia (ET) patients at diagnosis, is a feature clinically easy to assess, confirmable by echography with a very low chance of misinterpretation. Nonetheless, the clinical and prognostic role of splenomegaly has been seldom evaluated. From 1979 to 2013, 1297 ET patients retrospectively collected in the database of the Lazio Cooperative Group and Bologna University Hospital were evaluable for spleen enlargement at diagnosis and included in the analysis. On the whole, spleen was enlarged in 172/1297 (13.0%) patients; in most cases (94.8%) splenomegaly was mild (≤5 cm). Patients with splenomegaly were younger, predominantly male, presented higher platelet count and JAK2V617F allele burden and had a lower incidence of concomitant cardiovascular risk factors. At least one thrombotic event during follow‐up occurred in 97/1,125 (8.6%) patients without spleen enlargement compared to 27/172 (15.7%) patients with spleen enlargement (P = 0.003). Despite comparable use of cytoreductive/antiplatelet therapies in the two groups, the cumulative risk of thrombosis at 5 years was significantly higher in patients with baseline splenomegaly (9.8% versus 4.4% in patients without splenomegaly, P = 0.012). In multivariate analysis exploring risk factors for thrombosis, splenomegaly retained its negative prognostic role, together with previous thrombosis, leucocyte count and male gender. Baseline splenomegaly seems to be an independent additional risk factor for thrombosis in nonstrictly WHO‐defined ET patients. This data could be useful in the real‐life clinical management of these patients. Am. J. Hematol. 91:318–321, 2016. © 2016 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients

Andriani

Latagliata²,

Anaclerico

et al. 2016

American J Hematol

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“…The main causes of death are thrombotic events and evolution into myelofibrotic phase or secondary myelodisplasia/acute leukemia [3]; furthermore, the most frequent complications occurring in ET patients are either arterial or venous thromboses [4]. The treatment of ET patients with cytoreductive drugs is effective in reducing the incidence of these thrombotic events [5] but could be associated with an higher rate of leukemic evolution.…”

Section: Introductionmentioning

confidence: 99%

Thrombosis and survival in essential thrombocythemia: A regional study of 1,144 patients

Montanaro

Latagliata

Cedrone³

et al. 2014

American J Hematol

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To identify prognostic factors affecting thrombosis-free survival (TFS) and overall survival (OS), we report the experience of a Regional cooperative group in a real-life cohort of 1,144 patients with essential thrombocythemia (ET) diagnosed from January 1979 to December 2010. There were 107 thrombotic events (9.4%) during follow-up [60 (5.3%) arterial and 47 (4.1%) venous thromboses]. At univariate analysis, risk factors for a shorter TFS were: age >60 years (P < 0.0054, 95% CI 1.18-2.6), previous thrombosis (P < 0.0001, 95% CI 1.58-4.52) and the presence of at least one cardiovascular risk factor (P 5 0.036, 95% CI 1.15-3.13). Patients with a previous thrombosis occurred 24 months before ET diagnosis had a shorter TFS compared to patients with a previous thrombosis occurred <24 months (P 5 0.0029, 95% CI 1.5-6.1); furthermore, patients with previous thrombosis occurred <24 months did not show a shorter TFS compared with patients without previous thrombosis (P 5 0.303, 95% CI 0.64-3.21). At multivariate analysis for TFS, only the occurrence of a previous thrombosis maintained its prognostic impact (P 5 0.0004, 95% CI 1.48-3.79, RR 2.36). The 10-year OS was 89.9% (95% CI 87.3-92.5): at multivariate analysis for OS, age >60 years (P < 0.0001), anemia (P < 0.0001), male gender (P 5 0.0019), previous thromboses (P 5 0.0344), and white blood cell >15 3 10 9 /l (P 5 0.0370) were independent risk factors. Previous thrombotic events in ET patients are crucial for TFS but their importance seems related not to the occurrence per se but mainly to the interval between the event and the diagnosis.

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“…Elevated values are also seen among patients suffering from polycythemia, chronic myeloid leukemia, acute infections and chronic inflammatory conditions [1].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown a risk as low as 1.6% for a thromboembolic complication of reactive thrombocytosis. This is why it is generally not recommended to treat with aspirin for prophylactic purposes in patients with reactive thrombocytosis [1].…”

Section: Discussionmentioning

confidence: 99%

Reactive Thrombocytosis

Guldfeldt

2013

J Med Cases

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This case report is about a patient who went through a small abdominal operation and afterwards was diagnosed with thrombocytosis. It was found retrospectively that the patient for some time had had thrombocytosis. The patient was referred to the haematological department for further testing. There was no evidence of myeloproliferative disease, instead there was found a 13 mm. malignancy suspect infiltrate located to the base of the right lung. The patient went through curative surgery. However there was found a small metastasis in a lymph node and the patient was given adjuvant chemotherapy, 3 months postoperatively, there is still decreasing platelets of 535 × 10 9 /L and the patient is considered cured.

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Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies

Cited by 119 publications

References 169 publications

Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients

Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients

Thrombosis and survival in essential thrombocythemia: A regional study of 1,144 patients

Reactive Thrombocytosis

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