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Current Hematologic Malignancy Reports

, Volume 12, Issue 5, pp 389–396 | Cite as

Risk Factors for and Management of MPN-Associated Bleeding and Thrombosis

  • Karlyn MartinEmail author
Myeloproliferative Neoplasms (B Stein, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Myeloproliferative Neoplasms

Abstract

Purpose of the Review

The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are characterized by both thrombotic and bleeding complications. The purpose of this review is to describe the risk factors associated with bleeding and thrombosis in MPN, as well as to review prevention strategies and management of these complications.

Recent Findings

Well-described risk factors for thrombotic complications include older age and history of prior thrombosis, along with traditional cardiovascular and venous thromboembolic risk factors. More recently, JAK2 V617F mutation has been found to carry an increased risk of thrombotic complications, whereas CALR has a lower risk than JAK2 mutation. Factors associated with an increased risk of bleeding in MPN include a prior history of bleeding, acquired von Willebrand syndrome, and primary myelofibrosis. Recent findings suggest that thrombocytosis carries a higher risk of bleeding than thrombosis in MPN, and aspirin may exacerbate this risk of bleeding, particularly in CALR-mutated ET.

Summary

Much of the management of MPN focuses on predicting risk of bleeding and thrombosis and initiating prophylaxis to prevent complications in those at high risk of thrombosis. Emerging evidence suggests that sub-populations may have bleeding risk that outweighs thrombotic risk, particularly in setting of antiplatelet therapy. Future work is needed to better characterize this balance. At present, a thorough assessment of the risks of bleeding and thrombosis should be undertaken for each patient, and herein, we review risk factors for and management of these complications.

Keywords

Myeloproliferative neoplasm (MPN) Essential thrombocythemia (ET) Polycythemia vera (PV) Primary myelofibrosis (PMF) Thrombosis Hemorrhage 

Notes

Compliance with Ethical Standards

Conflict of Interest

The author declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Hematology/Oncology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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