Thromb Haemost 2021; 121(05): 553-564
DOI: 10.1055/s-0040-1720979
Review Article

Hemorrhage in Essential Thrombocythemia or Polycythemia Vera: Epidemiology, Location, Risk Factors, and Lessons Learned from the Literature

Christophe Nicol
1  Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France
,
Karine Lacut
2  Département de Médecine Interne et Pneumologie, CHRU de Brest, Bretagne, France
3  GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France
,
Brigitte Pan-Petesch
1  Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France
3  GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France
,
Eric Lippert
4  Laboratoire d'Hématologie, CHRU de Brest, Bretagne, France
5  FIM, France Intergroupe des Néoplasies Myéloprolifératives, France
,
Jean-Christophe Ianotto
1  Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France
3  GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France
5  FIM, France Intergroupe des Néoplasies Myéloprolifératives, France
› Author Affiliations

Abstract

Hemorrhage is a well-known complication of essential thrombocythemia (ET) and polycythemia vera (PV), but evidence-based data on its management and prevention are lacking to help inform clinicians. In this review, appropriate published data from the past 15 years regarding bleeding epidemiology, classification, location, and risk factors are presented and discussed. Research was conducted using the Medline database. The bleeding classifications were heterogeneous among the collected studies. The median incidences of bleeding and major bleeding were 4.6 and 0.79% patients/year, in ET patients and 6.5 and 1.05% patients/year in PV patients, respectively. The most frequent location was the gastrointestinal tract. Bleeding accounted for up to 13.7% of deaths, and cerebral bleeding was the main cause of lethal hemorrhage. Thirty-nine potential risk factors were analyzed at least once, but the results were discrepant. Among them, age >60 years, bleeding history, splenomegaly, myeloproliferative neoplasm subtype, and platelet count should deserve more attention in future studies. Among the treatments, aspirin seemed to be problematic for young patients with ET (especially CALR-mutated ET patients) and anagrelide was also identified as a bleeding inducer, especially when associated with aspirin. Future studies should analyze bleeding risk factors in more homogeneous populations and with common bleeding classifications. More tools are needed to help clinicians manage the increased risk of potentially lethal bleeding events in these diseases.

Authors' Contributions

C.N., J-.C.I., B.P-.P., and K.L. elaborated the study. C.N. did the PubMed analysis. C.N. and J-.C.I. wrote the manuscript. B.P-.P., K.L., and E.L. reviewed the manuscript. All the authors have validated the final version of the manuscript.


Supplementary Material



Publication History

Received: 26 May 2020

Accepted: 30 September 2020

Publication Date:
13 November 2020 (online)

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