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Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncology (ÖGHO) and Society of Thrombosis and Haemostasis Research (GTH e.V.)

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Abstract

Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) like polycythemia vera and essential thrombocythemia are at increased risk of arterial and venous thrombosis. Strategies of prevention may consist of platelet aggregation inhibitors and/or cytoreductive agents depending on the underlying disease and the individual risk. Clinical evidence for management of acute venous thromboembolic events in MPN patients is limited. Modality and duration of therapeutic anticoagulation after venous thrombosis has to be evaluated critically with special regard to the increased risk for spontaneous bleeding events associated with the underlying diseases. Both for therapy of the acute event and for secondary prophylaxis, low-molecular-weight heparins should preferentially be used. A prolongation of the therapeutic anticoagulation beyond the usual 3 to 6 months can only be recommended in high-risk settings and after careful evaluation of potential risks and benefits for the individual patient. New direct oral anticoagulants (NOAC) should not preferentially be used due to lack of clinical experience in patients with MPN and potential drug interactions (e.g. with JAK inhibitors). Consequent treatment of the underlying myeloproliferative disease and periodical evaluation of the response to therapy is crucial for optimal secondary prophylaxis of thromboembolic events in those patients.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Charite Berlin, Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Stephan Kreher, Sebastian Ochsenreither & Hanno Riess

  2. Department of Hematology and Oncology, DIAKO, Ev. Diakonie-Krankenhaus GmbH, Bremen, Germany

    Ralf U. Trappe

  3. Clinical Department for Hematology and Hemostaseology, Vienna General Hospital–University Clinic, Vienna, Austria

    Ingrid Pabinger

  4. MVZ Wagnerstibbe Für Laboratoriumsmedizin Und Pathologie GmbH, Hannover, Germany

    Frauke Bergmann

  5. Hematology Oncology Center, Munich Isartor, Munich, Germany

    Petro E. Petrides

  6. Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany

    Steffen Koschmieder

  7. Department of Hematology and Oncology, Caritas Klinikum Saarbrücken, Saarbrücken, Germany

    Axel Matzdorff

  8. Department for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany

    Andreas Tiede

  9. Department of Hematology, Oncology and Palliative Care, Mühlenkreiskliniken Johannes Wesling Klinikum Minden, Minden, Germany

    Martin Griesshammer

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  1. Stephan Kreher
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Correspondence to Stephan Kreher.

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Kreher, S., Ochsenreither, S., Trappe, R.U. et al. Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncology (ÖGHO) and Society of Thrombosis and Haemostasis Research (GTH e.V.). Ann Hematol 93, 1953–1963 (2014). https://doi.org/10.1007/s00277-014-2224-8

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