THROMBOTIC AND HEMORRHAGIC COMPLICATIONS IN CHRONIC MYELOPROLIFERATIVE DISORDERS

Bleeding and thrombosis are major causes of morbidity and mortality in patients with chronic myeloproliferative disorders. We retrospectivel y evaluated 101 consecutive patients affected by primary thrombocytosi s (46 male, 55 female. aged 18-84 years; mean+/-SD 61+/-15) followed f or a period ranging from 6 months up to 10 years (median 5 years) at o ur hematological unit, At the time of diagnosis 48 patients were asymp tomatic; 26 had clinical evidence of atherothrombosis (cerebral ischem ic attacks, ischemic heart disease, peripheral occlusive arterial dise ase), ten had venous thrombosis, four experienced major hemorrhages, 2 3 presented microvascular ischemic manifestations namely erythromelalg ia, paresthesias, acrocyanosis and dizziness. At presentation 51.2% of the patients had elevated serum lactic dehydrogenase, 34.5% hyperuric emia, and 23.4%, serum creatinine > 1.2 mg/dL. Color Doppler ultrasoun d provided evidence of vascular stenosis or medium-intimal hyperplasia of epiaortic vessels in 48.9% of patients studied, and similar altera tions of lower limb arteries in 23.8% of cases. Therapy modality inclu ded an antiplatelet agent (picotamide 300 mg/bid); a cytoreductive age nt (busulphan, hydroxyurea, pipobroman or melphalan) was used when pla telet count was > 800000/mu L. Symptoms due to microvascular ischemia promptly regressed after picotamide and cytoreductive therapy. During follow-up. nine patients suffered from atherothrombotic events (transi ent ischemic attacks, ischemic stroke, unstable angina pectoris) and f ive developed deep vein thrombosis or superficial thrombophlebitis, Fi ve patients experienced major hemorrhages (two melena, two hematuria, one perioperative bleeding): the two gastrointestinal hemorrhages occu rred in patients self-medicated with non steroidal anti-inflammatory d rugs, and the two episodes of hematuria occurred on oral anticoagulant therapy and aspirin respectively. No major bleeding occurred in patie nts on continuative therapy with picotamide, even in the presence of u pper digestive tract disorders. Seven patients died: mortality resulte d from one sudden coronary death, three solid neoplasia, one blast cri sis, one anile, and one massive hemorrhage due to abdominal aortic pro sthesis tearing, Our study suggests that a long-term antithrombotic pr ophylaxis with picotamide may be of benefit in patients affected by pr imary thrombocytosis; a controlled clinical trial is warranted to asse ss whether picotamide can ameliorate the natural history of the diseas e.