Arterial and venous thromboses are the most significant complications in patients with myeloproliferative neoplasms (MPN), with the primary treatment goal being thrombotic risk reduction. In MPN with no history of thrombosis, primary prevention mainly involves the use of aspirin and cytoreduction is added in high-risk patients. However, thrombotic complications can unveil an MPN in approximately 20% of cases, necessitating the initiation of both antithrombotic therapy for the thrombosis and cytoreductive treatment for the MPN. The duration of anticoagulant therapy following an initial venous thromboembolic event (VTE) is subject to discussion. Furthermore, the occurrence of a thrombotic complication in patients with a known diagnosis of MPN prompts a reconsideration of both antithrombotic and hematological management. This review employs case-based discussions to explore the management of thrombotic complications in MPN patients. It addresses the nature and duration of antithrombotic treatments, as well as the approach to cytoreduction. Special attention is given to the place of direct oral anticoagulants and to the management of MPN patients with splanchnic vein thrombosis, which is disproportionately common in this group.
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Review Article|
November 14, 2024
How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms
Alexandre Guy,
Alexandre Guy
Univ. Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, Pessac, France
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Pierre-Emmanuel Morange,
Pierre-Emmanuel Morange
Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Chloé James
University Hospital Bordeaux, Pessac, France
* Corresponding Author; email: [email protected]
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Blood blood.2024025627.
Article history
Submitted:
July 24, 2024
Revision Received:
October 23, 2024
Accepted:
October 24, 2024
Citation
Alexandre Guy, Pierre-Emmanuel Morange, Chloé James; How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms. Blood 2024; blood.2024025627. doi: https://doi.org/10.1182/blood.2024025627
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