Anticoagulation for splanchnic vein thrombosis in myeloproliferative neoplasms: a systematic review and meta-analysis.
Pavlina Chrysafi, Kevin Barnum, Genevieve M Gerhard, Thita Chiasakul, Arshit Narang, Megan Mcnichol, Nicoletta Riva, Georg Semmler, Bernhard Scheiner, Stefan Acosta, Pierre-Emmanuel Rautou, Mandy N Lauw, Jonathan Berry, Walter Ageno, Jeffrey I Zwicker, Rushad Patell
Author Information
Pavlina Chrysafi: Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA. Electronic address: https://twitter.com/PavlinaChrysafi.
Kevin Barnum: Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Genevieve M Gerhard: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Thita Chiasakul: Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Arshit Narang: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Megan Mcnichol: Department of Information Systems, Division of Knowledge Services, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Nicoletta Riva: Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Georg Semmler: Department of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria.
Bernhard Scheiner: Department of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria.
Stefan Acosta: Department of Clinical Sciences, Lund University, Lund, Sweden.
Pierre-Emmanuel Rautou: Department of Immunology, Institut National de la Santé et de la Recherche Médicale (Inserm), Centre de Recherche sur l'Inflammation, Unité Mixte de Recherche (UMR) 1149, Université Paris-Cité, Paris, France; Division of Hepatology, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Beaujon, Service d'Hépatologie, Département Médico-Universitaire (DMU) DIGEST, Centre de Référence des Maladies Vasculaires du Foie, Filière des Maladies Hépatiques Rares (FILFOIE), European Reference Network for Rare Liver Diseases (ERN RARE-LIVER), Clichy, France.
Mandy N Lauw: Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Jonathan Berry: Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Walter Ageno: Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Jeffrey I Zwicker: Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
Rushad Patell: Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rpatell@bidmc.harvard.edu.
BACKGROUND: Optimal anticoagulation management in patients with myeloproliferative neoplasms (MPN) experiencing splanchnic vein thrombosis (SpVT) requires balancing risks of bleeding and recurrent thrombosis. OBJECTIVES: We conducted a systematic review and meta-analysis to assess the incidence of bleeding and thrombosis recurrence in patients with MPN-SpVT. METHODS: We included retrospective or prospective studies in English with ≥10 adult patients with MPN-SpVT. Outcomes included recurrent venous thrombosis (SpVT and non-SpVT), arterial thrombosis, and major bleeding. Pooled rates per 100 patient years with 95% CIs were calculated by DerSimonian-Laird method using random-effects model. RESULTS: Out of 4624 studies screened, 9 studies with a total of 443 patients were included in the meta-analysis with median follow-up of 3.5 years. In the 364 patients with MPN-SpVT treated with anticoagulation, pooled event rate for major bleeding was 2.8 (95% CI, 1.5-5.1; I = 95%), for recurrent venous thrombosis was 1.4 (95% CI, 0.8-2.2; I = 72%), and for arterial thrombosis was 1.4 (95% CI, 0.6-3.3; I = 92%) per 100 patient years. Among 79 patients (n = 4 studies) who did not receive anticoagulation, pooled event rate for major bleeding was 3.2 (95% CI, 0.7-12.7; I = 97%), for recurrent venous thrombosis 3.5 (95% CI, 1.8-6.4; I = 88%), and for arterial thrombosis rate 1.6 (95% CI, 0.4-6.6; I = 95%) per 100 patient years. CONCLUSION: Patients with MPN-SpVT treated with anticoagulation have significant risks for both major bleeding and thrombosis recurrence. Further studies are necessary to determine the optimal anticoagulation approach in patients with MPN-SpVT.
