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Hamostaseologie 2020; 40(01): 047-053
DOI: 10.1055/s-0040-1701474
Review Article
Georg Thieme Verlag KG Stuttgart · New York

How I Manage Thrombotic/Thromboembolic Complications in Myeloproliferative Neoplasms

How I treat: Thrombotische/thromboembolische Komplikationen bei Patienten mit Myeloproliferativen Neoplasien
Steffen Koschmieder
1   Department of Medicine (Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation), Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Publikationsverlauf

23. Juli 2019

15. Dezember 2019

Publikationsdatum:
12. Februar 2020 (online)

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Abstract

Patients with myeloproliferative neoplasms (MPNs), such as polycythemia vera, essential thrombocythemia, and primary myelofibrosis, are at increased risk for arterial and venous thrombosis/thromboembolism. In particular, the risk of splanchnic venous thrombosis, such as portal vein thrombosis or Budd–Chiari syndrome, is significantly higher in patients with MPN than in the normal population. At the same time, MPN patients are at increased risk for severe bleeding. Therefore, the treatment of patients with MPN must be based on their suspected probability of thrombosis/thromboembolism and bleeding. For this purpose, patient and MPN-specific risk factors are used. Patients at expected high risk of thrombosis should receive adequate primary or secondary thromboprophylaxis in addition to cytoreductive therapy. This may consist of antiplatelet agents and/or anticoagulant agents and must be balanced with the individual bleeding risk. The goal is to increase the quality of life and life span of patients with MPNs by preventing (re-)thrombosis and severe bleeding.

Zusammenfassung

Patienten mit Myeloproliferativen Neoplasien (MPN), wie der Polycythämia vera (PV), Essentiellen Thrombozythämie (ET) und Primären Myelofibrose (PMF), sind einem erhöhten Risiko für arterielle und venöse Thromboembolien ausgesetzt. Besonders das Risiko für splanchnische Venenthrombosen, wie die Pfortaderthrombose oder das Budd-Chiari-Syndrom, ist bei Patienten mit MPN vielfach höher als in der Normalbevölkerung. Gleichzeitig besteht bei MPN-Patienten ein erhöhtes Risiko für schwergradige Blutungen. Daher muß sich die Therapie der Patienten mit MPN an der Wahrscheinlichkeit für Thromboembolien und Blutungen orientieren. Hierfür werden patienten- und MPN-spezifische Risikofaktoren herangezogen. Patienten mit zu erwartendem hohem Risiko für Thrombosen sollten zusätzlich zu einer zytoreduktiven Therapie eine angemessene Primär- oder Sekundärprophylaxe erhalten. Diese kann aus Thrombozytenfunktionshemmern und/oder Antikoagulanzien bestehen und muß mit dem individuellen Blutungsrisiko balanciert werden. Ziel ist es, durch die Verhinderung von (Re-)Thrombosen und schwergradigen Blutungen die Lebensqualität und Lebensspanne der Patienten mit MPN zu erhöhen.

Keywords

myeloproliferative neoplasms (MPNs) - thrombosis/thromboembolism - therapy - anticoagulation - cytoreduction - polycythemia vera (PV) - essential thrombocythemia (ET) - primary myelofibrosis (PMF)

Schlüsselwörter

Myeloproliferative Neoplasien (MPN)Thrombosen/Thromboembolien - Therapie - Antikoagulation - Zytoreduktion - Polycythämia vera (PV) - Essentielle - Thrombozythämie (ET) - Primäre Myelofibrose (PMF)
 

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