Antiplatelet therapy versus observation in low-risk essential thrombocythemia with CALR mutation

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...

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Detalles Bibliográficos
Autores: Álvarez Larrán, Alberto, Pereira Saavedra, Arturo, Guglielmelli, Paola, Hernández Boluda, Juan Carlos, Arellano Rodrigo, Eduardo, Ferrer Marín, Francisca, Samah, Alimam, Griesshammer, Martin, Kerguelen Fuentes, Ana, Andreasson, Bjorn, Burgaleta, Carmen, Schwarz, Jiri, García Gutiérrez, Valentín, Ayala, Rosa, Barba, Pere, Gómez Casares, María Teresa, Paoli, Chiara, Drexler, Beatrice, Zweegman, Sonja, McMullin, Mary F., Samuelsson, Jan, Harrison, Claire N., Cervantes Requena, F., Vannucchi, Alessandro M., Besses, Carlos
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/108856
Acceso en línea:https://hdl.handle.net/2445/108856
Access Level:acceso abierto
Palabra clave:Trombosi
Plaquetes sanguínies
Malalties hematològiques
Thrombosis
Blood platelets
Hematologic diseases
Descripción
Sumario: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.

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