Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia
Por:
Alvarez-Larran, A, Cervantes, F, Pereira, A, Arellano-Rodrigo, E, Perez-Andreu, V, Hernandez-Boluda, JC, Ayats, R, Salvador, C, Muntanola, A, Bellosillo, B, Vicente, V, Hernandez-Nieto, L, Burgaleta, C, Xicoy, B, Besses, C
Publicada:
26 ago 2010
Resumen:
The effectiveness of antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia (ET) is not proven. In this study, the incidence rates of arterial and venous thrombosis were retrospectively analyzed in 300 low-risk patients with ET treated with antiplatelet drugs as monotherapy (n = 198) or followed with careful observation (n = 102). Follow-up was 802 and 848 person-years for antiplatelet therapy and observation, respectively. Rates of thrombotic events were 21.2 and 17.7 per 1000 person-years for antiplatelet therapy and observation, respectively (P = .6). JAK2 V617F-positive patients not receiving antiplatelet medication showed an increased risk of venous thrombosis (incidence rate ratio [IRR]: 4.0; 95% CI: 1.2-12.9; P = .02). Patients with cardiovascular risk factors had increased rates of arterial thrombosis while on observation (IRR: 2.5; 95% CI: 1.02-6.1; P = .047). An increased risk of major bleeding was observed in patients with platelet count greater than 1000 x 10(9)/L under antiplatelet therapy (IRR: 5.4; 95% CI: 1.7-17.2; P = .004). In conclusion, antiplatelet therapy reduces the incidence of venous thrombosis in patients with JAK2-positive ET and the rate of arterial thrombosis in patients with associated cardiovascular risk factors. In the remaining low-risk patients, this therapy is not effective as primary prophylaxis of thrombosis, and observation may be an adequate option. (Blood. 2010; 116(8): 1205-1210)
Filiaciones:
Alvarez-Larran, A:
Hosp Mar, Dept Hematol, Barcelona 08003, Spain
Cervantes, F:
Univ Barcelona, Dept Hematol, Hosp Clin, IDIBAPS, Barcelona, Spain
Pereira, A:
Hosp Clin Barcelona, Hemotherapy & Hemostasis Serv, Barcelona, Spain
Arellano-Rodrigo, E:
Hosp Clin Barcelona, Hemotherapy & Hemostasis Serv, Barcelona, Spain
Hosp Gen Valle Hebron, Dept Hematol, Barcelona, Spain
Perez-Andreu, V:
Hosp Morales Messeguer, Dept Hematol, Murcia, Spain
Hernandez-Boluda, JC:
Hosp Clin, Dept Hematol, Valencia, Spain
Ayats, R:
Hosp Santa Creu & Sant Pau, Dept Hematol, Barcelona, Spain
Salvador, C:
Hosp Miguel Servet, Dept Hematol, Zaragoza, Spain
Muntanola, A:
Mutua Terrassa, Dept Hematol, Terrassa, Spain
Bellosillo, B:
Hosp Mar, Dept Pathol, Barcelona 08003, Spain
Vicente, V:
Hosp Morales Messeguer, Dept Hematol, Murcia, Spain
Hernandez-Nieto, L:
Hosp Univ Canarias, Dept Hematol, Tenerife, Spain
Burgaleta, C:
Univ Alcala de Henares, Dept Hematol, Hosp Principe Asturias, Madrid, Spain
Xicoy, B:
Hosp Badalona Germans Trias & Pujol, Dept Hematol, Badalona, Spain
Besses, C:
Hosp Mar, Dept Hematol, Barcelona 08003, Spain
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