TY - JOUR
T1 - Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation
AU - Alvarez-Larrán, Alberto
AU - Pereira, Arturo
AU - Guglielmelli, Paola
AU - Hernández-Boluda, Juan Carlos
AU - Arellano-Rodrigo, Eduardo
AU - Ferrer-Marín, Francisca
AU - Samah, Alimam
AU - Griesshammer, Martin
AU - Kerguelen, Ana
AU - Andreasson, Bjorn
AU - Burgaleta, Carmen
AU - Schwarz, Jiri
AU - García-Gutiérrez, Valentín
AU - Ayala, Rosa
AU - Barba, Pere
AU - Gómez-Casares, María Teresa
AU - Paoli, Chiara
AU - Drexler, Beatrice
AU - Zweegman, Sonja
AU - McMullin, Mary F.
AU - Samuelsson, Jan
AU - Harrison, Claire
AU - Cervantes, Francisco
AU - Vannucchi, Alessandro M.
AU - Besses, Carlos
PY - 2016/7/31
Y1 - 2016/7/31
N2 - © 2016 Ferrata Storti Foundation. The role of antiplatelet therapy as primary prophylaxis of thrombosis in low-risk essential thrombocythemia has not been studied in randomized clinical trials. We assessed the benefit/risk of lowdose aspirin in 433 patients with low-risk essential thrombocythemia (271 with a CALR mutation, 162 with a JAK2V617F mutation) who were on antiplatelet therapy or observation only. After a follow up of 2215 person-years free from cytoreduction, 25 thrombotic and 17 bleeding episodes were recorded. In CALR-mutated patients, antiplatelet therapy did not affect the risk of thrombosis but was associated with a higher incidence of bleeding (12.9 versus 1.8 episodes per 1000 patient-years, P=0.03). In JAK2V617F-mutated patients, low-dose aspirin was associated with a reduced incidence of venous thrombosis with no effect on the risk of bleeding. Coexistence of JAK2V617F-mutation and cardiovascular risk factors increased the risk of thrombosis, even after adjusting for treatment with low-dose aspirin (incidence rate ratio: 9.8; 95% confidence interval: 2.3-42.3; P=0.02). Time free from cytoreduction was significantly shorter in CALR-mutated patients with essential thrombocythemia than in JAK2V617F-mutated ones (median time 5 years and 9.8 years, respectively; P=0.0002) and cytoreduction was usually necessary to control extreme thrombocytosis. In conclusion, in patients with low-risk, CALR-mutated essential thrombocythemia, low-dose aspirin does not reduce the risk of thrombosis and may increase the risk of bleeding.
AB - © 2016 Ferrata Storti Foundation. The role of antiplatelet therapy as primary prophylaxis of thrombosis in low-risk essential thrombocythemia has not been studied in randomized clinical trials. We assessed the benefit/risk of lowdose aspirin in 433 patients with low-risk essential thrombocythemia (271 with a CALR mutation, 162 with a JAK2V617F mutation) who were on antiplatelet therapy or observation only. After a follow up of 2215 person-years free from cytoreduction, 25 thrombotic and 17 bleeding episodes were recorded. In CALR-mutated patients, antiplatelet therapy did not affect the risk of thrombosis but was associated with a higher incidence of bleeding (12.9 versus 1.8 episodes per 1000 patient-years, P=0.03). In JAK2V617F-mutated patients, low-dose aspirin was associated with a reduced incidence of venous thrombosis with no effect on the risk of bleeding. Coexistence of JAK2V617F-mutation and cardiovascular risk factors increased the risk of thrombosis, even after adjusting for treatment with low-dose aspirin (incidence rate ratio: 9.8; 95% confidence interval: 2.3-42.3; P=0.02). Time free from cytoreduction was significantly shorter in CALR-mutated patients with essential thrombocythemia than in JAK2V617F-mutated ones (median time 5 years and 9.8 years, respectively; P=0.0002) and cytoreduction was usually necessary to control extreme thrombocytosis. In conclusion, in patients with low-risk, CALR-mutated essential thrombocythemia, low-dose aspirin does not reduce the risk of thrombosis and may increase the risk of bleeding.
U2 - 10.3324/haematol.2016.146654
DO - 10.3324/haematol.2016.146654
M3 - Article
VL - 101
SP - 926
EP - 931
IS - 8
ER -