CEREBRAL VASCULAR ACCIDENTS IN YOUNG-PATIENTS WITH ESSENTIAL THROMBOCYTHEMIA - RELATION WITH OTHER KNOWN CARDIOVASCULAR RISK-FACTORS

Background and purpose: Since the advent of routine automated blood ce ll counts, an increased platelet count often is detected fortuitously in asymptomatic individuals. In the past, essential thrombocythemia (E T) was thought to be linked to an increase incidence of hemorrhagic co mplications, whereas thrombosis is now considered more frequently. Act ually, the risk of thrombosis cannot be predicted in an asymptomatic p atient with essential thrombocythemia. Patients and methods: A total o f 41 young patients (age range, 18 to 45 years:) affected by ET and di agnosed in agreement with the Polycythemia Vera Study Group criteria a re reported. Common risk factors, such as hypertension, smoke, obesity , dyslipidemia, and diabetes, have been registered. Particular attenti on has been given to cerebral vascular accidents (CVA) both of the art erial and venous systems. Platelet number, platelet serotonin content, and platelet aggregation under collagen, adenosine diphosphate (ADP), and adrenalin stimuli were evaluated. Results: Nine out of the 41 pat ients affected by ET had CVAs, four of which occurred in the venous sy stem. No difference in platelet function tests has been observed betwe en patients with or without CVA. Six out of the 9 patients with ET and CVA had at least one atherosclerotic risk factor: four were heavy smo kers, one had hypertension, and one had hypertension and obesity. Conc lusions: Cerebral vascular accidents are confirmed to be frequent in p atients with essential thrombocythemia, even at: a young age. However, the presence of at least one atherosclerotic risk factor associated w ith increased platelet number seems to favor thrombotic complications. In particular, cigarette smoking seems to be related to arterial CVAs in essential thrombocythemia.