Managing thrombotic and bleeding complications in patients with MPNs

Craig Kessler, MD, Georgetown University School of Medicine, Washington, DC, gives an overview of his presentation on anticoagulation management in myeloproliferative neoplasms (MPNs). Thrombotic and bleeding complications are common in patients with all MPN subtypes including polycythemia vera, essential thrombocythemia and primary myelofibrosis. In order to prevent these complications, it is critical to improve our understanding of the epidemiology of thrombosis and bleeding. Moreover, whilst it is known that Janus Kinase 2 (JAK2) burden and specific comorbidities are associated with an increased incidence of splenic and cerebral venous thromboses, the underlying factors increasing the risk of these complications in patients with MPNs are currently not well understood. In addition, Prof. Kessler explains that there have been no adequately powered clinical trials assessing thrombotic outcomes with current anticoagulation strategies including unfractionated heparin (UFH), low-molecular-weight heparins (LMWHs), warfarin and direct oral anticoagulation approaches. In the future, Prof. Kessler describes how it is essential to conduct biomarker-driven studies to assess those strategies and identify patient subgroups that are more likely to develop thrombotic and bleeding complications. Finally, Prof. Kessler explains that patients with essential thrombocythemia infected with COVID-19 are at an increased risk of thrombosis, bleeding and death due to the contribution of the inflammasome to coagulation. This interview took place at the 2021 International Congress on MPNs congress in New York, NY.