In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (−23.3%, p < 0.0001) than in PV (−16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19 / T. Barbui, V. De Stefano, A. Alvarez-Larran, A. Iurlo, A. Masciulli, A. Carobbio, A. Ghirardi, A. Ferrari, V. Cancelli, E.M. Elli, M.M. Andrade-Campos, M.G. Kabat, J.-. Kiladjian, F. Palandri, G. Benevolo, V. Garcia-Gutierrez, M.L. Fox, M.A. Foncillas, C.M. Morcillo, E. Rumi, S. Osorio, P. Papadopoulos, M. Bonifacio, K.S.Q. Cervantes, M.S. Serrano, G. Carreno-Tarragona, M.A. Sobas, F. Lunghi, A. Patriarca, B.N. Elorza, A. Angona, E.M. Mazo, S. Koschmieder, G. Carli, B. Cuevas, J.C. Hernandez-Boluda, E.L. Abadia, B.X. Cirici, P. Guglielmelli, M. Garrote, D. Cattaneo, R. Daffini, F. Cavalca, B. Bellosillo, L. Benajiba, N. Curto-Garcia, M. Bellini, S. Betti, C. Harrison, A. Rambaldi, A.M. Vannucchi. - In: BLOOD CANCER JOURNAL. - ISSN 2044-5385. - 11:2(2021), pp. 21.1-21.11. [10.1038/s41408-021-00417-3]
Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19
D. Cattaneo;A. Rambaldi;
2021
Abstract
In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (−23.3%, p < 0.0001) than in PV (−16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
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