Abstract
Low-dose acetylsalicylic acid (ASA) is given to most patients with polycythemia vera (PV) and essential thrombocythemia (ET) although some uncertainties encompass this clinical practice. In patients with history of thrombosis, the use of ASA is supported on the results observed in the general population showing a substantial net benefit of this treatment in preventing thrombosis. In the European collaboration study on low-dose aspirin in polycythemia vera (ECLAP), ASA reduced the risk of thrombosis without increasing the risk of major bleeding when compared with placebo, supporting the primary prevention of thrombosis in PV. In ET, the efficacy of low-dose ASA has not been tested in randomized clinical trials. Two retrospective studies have shown that low-dose ASA could benefit ET patients older than 60 years when combined with cytoreduction, whereas in young, low-risk patients, ASA benefits to particular subgroups of patients. In spite of the fact that in primary myelofibrosis the incidence of thrombosis is increased, the use of ASA is not clearly recommended.
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References
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Barbui T, Barosi G, Birgegard G, Cervantes F, Finazzi G, Griesshammer M, et al. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet. J Clin Oncol. 2011;29(6):761–70.
Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350(2):114–24.
Rocca B, Ciabattoni G, Tartaglione R, Cortelazzo S, Barbui T, Patrono C, et al. Increased thromboxane biosynthesis in essential thrombocythemia. Thromb Haemost. 1995;74:1225–30.
Van Genderen PJ, Michiels JJ, van Strik R, Lindemans J, van Vliet HH. Platelet consumption in thrombocythemia complicated by erythromelalgia: reversal by aspirin. Thromb Haemost. 1995;73:210–4.
Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–60.
De Stefano V, Za T, Rossi E, Vannucchi AM, Ruggeri M, Elli E, et al. Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: incidence, risk factors, and effect of treatments. Haematologica. 2008;93(3):372–80.
Gruppo Italiano Studio Policitemia (GISP). Low-dose aspirin in polycythaemia vera: a pilot study. Br J Haematol. 1997;97(2):453–6.
Squizzato A, Romualdi E, Passamonti F, Middeldorp S. Antiplatelet drugs for polycythaemia vera and essential thrombocythaemia. Cochrane Database Syst Rev. 2013;4, CD006503. Meta-analysis including randomized studies evaluating the benefit of ASA in polycythemia vera.
van Genderen PJ, Mulder PG, Waleboer M, van de Moesdijk D, Michiels JJ. Prevention and treatment of thrombotic complications in essential thrombocythaemia: efficacy and safety of aspirin. Br J Haematol. 1997;97(1):179–84.
Alvarez-Larrán A, Pereira A, Arellano-Rodrigo E, Hernández-Boluda JC, Cervantes F, Besses C. Cytoreduction plus low-dose aspirin versus cytoreduction alone as primary prophylaxis of thrombosis in patients with high-risk essential thrombocythaemia: an observational study. Br J Haematol. 2013;161(6):865–71. Retrospective study showing that the addition of ASA to cytoreduction reduces the risk of thrombosis in ET patients older than 60 years without history of thrombosis.
Alvarez-Larrán A, Cervantes F, Pereira A, Arellano-Rodrigo E, Pérez-Andreu V, Hernández-Boluda JC, et al. Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia. Blood. 2010;116(8):1205–10. Retrospective study in low- risk ET showing that antiplatelet therapy benefits two groups of patients, those with cardiovascular risk factors and those carrying the JAK2V617F mutation.
Randi ML, Rossi C, Fabris F, Menapace L, Girolami A. Aspirin seems as effective as myelosupressive agents in the prevention of rethrombosis in essential thrombocythemia. Clin Appl Thromb Hemost. 1999;5:131–5.
Budde U, van Genderen PJ. Acquired von Willebrand disease in patients with high platelet counts. Semin Thromb Hemost. 1997;23(5):425–31.
Klampfl T, Gisslinger H, Harutyunyan AS, Nivarthi H, Rumi E, Milosevic JD, et al. Somatic mutations of calreticulin in myeloproliferative neoplasms. N Engl J Med. 2013;369:2379–90.
Nangalia J, Massie CE, Baxter EJ, Nice FL, Gundem G, Wedge DC, et al. Somatic CALR mutations in myeloproliferative neoplasms with nonmutated JAK2. N Engl J Med. 2013;369:2391–405.
Rumi E, Pietra D, Ferretti V, Klampfl T, Harutyunyan AS, Milosevic JD, et al. JAK2 or CALR mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes. Blood. 2014;123(10):1544–51.
Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345(25):1809–17.
Pascale S, Petrucci G, Dragani A, Habib A, Zaccardi F, Pagliaccia F, et al. Aspirin-insensitive thromboxane biosynthesis in essential thrombocythemia is explained by accelerated renewal of the drug target. Blood. 2012;119(15):3595–603.
Tefferi A, Barbui T. Personalized management of essential thrombocythemia-application of recent evidence to clinical practice. Leukemia. 2013;27(8):1617–20.
Barbui T, Carobbio A, Cervantes F, Vannucchi AM, Guglielmelli P, Antonioli E, et al. Thrombosis in primary myelofibrosis: incidence and risk factors. Blood. 2010;115(4):778–82.
Acknowledgments
This work was supported by grants from the Spanish Health Ministry Instituto de Salud Carlos III EC 10–136, PI13/00557, AECC Cataluña 2011, FEDER (RD09/0076/00036, RD12/0036/0010, and PT13/0010/0005).
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Dr. Alberto Alvarez-Larrán and Dr. Carlos Besses each declare no potential conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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Alvarez-Larrán, A., Besses, C. Antiplatelet Therapy in the Management of Myeloproliferative Neoplasms. Curr Hematol Malig Rep 9, 319–323 (2014). https://doi.org/10.1007/s11899-014-0226-1
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DOI: https://doi.org/10.1007/s11899-014-0226-1