Arterial and venous thromboses are the most significant complications in patients with myeloproliferative neoplasms (MPNs), with the primary treatment goal being thrombotic risk reduction. In MPN with no history of thrombosis, primary prevention mainly involves the use of aspirin, and cytoreduction is added in high-risk patients. However, thrombotic complications can unveil an MPN in ∼20% of cases, necessitating the initiation of both antithrombotic therapy for the thrombosis and cytoreductive treatment for the MPN. The duration of anticoagulant therapy after an initial venous thromboembolic event is subject to discussion. Furthermore, the occurrence of a thrombotic complication in patients with a known diagnosis of MPN prompts a reconsideration of both antithrombotic and hematologic management. This review uses case-based discussions to explore the management of thrombotic complications in patients with MPN. It addresses the nature and duration of antithrombotic treatments, as well as the approach to cytoreduction. Special attention is given to the place of direct oral anticoagulants and to the management of patients with MPN with splanchnic vein thrombosis, which is disproportionately common in this group.
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Myeloproliferative Neoplasms|
April 17, 2025
How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms
Alexandre Guy,
Alexandre Guy
1Laboratory of Hematology, University Hospital Bordeaux, Pessac, France
2Biologie des Maladies Cardiovasculaires, U-1034, University of Bordeaux, INSERM, Pessac, France
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Pierre-Emmanuel Morange,
Pierre-Emmanuel Morange
3Laboratory of Hematology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
4Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Cardiovasculaire et Nutrition, University of Aix-Marseille, INSERM, Marseille, France
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Chloé James
Chloé James
1Laboratory of Hematology, University Hospital Bordeaux, Pessac, France
2Biologie des Maladies Cardiovasculaires, U-1034, University of Bordeaux, INSERM, Pessac, France
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Blood (2025) 145 (16): 1769–1779.
Article history
Submitted:
July 24, 2024
Accepted:
October 24, 2024
First Edition:
November 14, 2024
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Citation
Alexandre Guy, Pierre-Emmanuel Morange, Chloé James; How I approach the treatment of thrombotic complications in patients with myeloproliferative neoplasms. Blood 2025; 145 (16): 1769–1779. doi: https://doi.org/10.1182/blood.2024025627
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