Published on March 9, 2020
- Doctors may tend to underestimate thrombosis risk in myelofibrosis. A vascular risk scoring system would be helpful.
- Doctors don't know if aspirin can be helpful in treating myelofibrosis. Ropeginterferon is being looked at for reducing thrombosis risk.
- It's important to educate primary care providers about looking at blood counts and knowing when to refer to a specialist and when to keep an eye on the counts.
Myeloproliferative neoplasm expert Dr. Brady Stein from Northwestern University’s Feinberg School of Medicine shares data presented at a recent conference on how to assess risk factors that cause blood clots. Watch as Dr. Stein discusses scoring systems, drugs that could reduce the risks and specific situations in younger MPN patients that need to be watched more closely.
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Transcript | How Can Experts Manage Blood Clot Risks?
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Hello and welcome to Patient Power on location in Orlando, Florida. I’m Andrew Schorr. Why are we in Orlando? Because this is where each year there is a big medical convention—not always in Orlando. It moves around, but this year here more than 25,000 blood experts from around the world come, including blood cancer experts, and that means part of the discussion is about MPNs. I’ve been living with myelofibrosis for about eight years. You’re affected by it or a loved one. Let’s get the news.
So, starting across the way here we have our first expert Dr. Angela Fleischman from UC Irvine. Angela, thanks for being with us.
Thank you for having me.
Thank you. In the center is Dr. Brady Stein from Northwestern. And, Brady, thank you for being with us. And then on the right is Laura Michaelis from the Medical College of Wisconsin, Milwaukee.
Thank you so much, Andrew. It’s a pleasure to be here.
My particular session was focused on thrombosis emblating and other special situations. So, these are really important in the management of ET and PV but also myelofibrosis. So, I think one of the points that I made is that we tend to underestimate thrombosis risk and myelofibrosis. We always think about this in ET and polycythemia vera, but we think less about this in myelofibrosis. So, that was one important point.
I think part of problem is that in ET and PV we have a way to assess risks, so we can look at risk factors and identify those patients maybe we should be more aggressive with trying to reduce the risk of a blood clotting event. We haven’t had that for myelofibrosis. So, one of the abstracts that I was interested in, this is a poster, presents a vascular risk score for patients with early myelofibrosis. So, I think that was particularly important.
You need to be on a statin, something like that?
We don’t know about a statin. But I think we have to go back and think about who needs to be on an aspirin or not. That’s kind of an important point too. I mean it sounds very basic, but aspirin can cause harms. So, in polycythemia vera, there’s justification to use it. Most of us see aspirin being given to almost all patients with ET, but that’s not necessarily beneficial to all patients. Some patients have more bleeding than they have protection.
In myelofibrosis, we really don’t know who should get aspirin or not. We have the least amount of data there. So, statins are certainly prime for investigation, but we can go back even to the basics and look at aspirin and think about who may be a suitable candidate. So, that was one area of interest for sure.
I’m also interested in drugs that can reduce thrombosis risk, so like Dr. Michaelis I am interested in the presentation on ropeginterferon tomorrow morning, because over a four-year period they’re presenting a very low risk of thrombotic events, blood-clotting events. So, that’s definitely of interest.
I’m also interested in what I call special situations, because there are a few situations that affect younger patients, and one of those is clotting in an unusual vascular bed. We call this the splanchnic circulation. So, that means a clot in the hepatic vein or in the portal vein—so, veins that drain the liver or the intestines. And this type of clotting event has been long associated with MPNs, but the very interesting part about it is that it affects younger women. It’s very distinct. So, this is very different than MPN at large. This is a clotting event that we often see in younger women. This is often their presenting feature of a myeloproliferative neoplasm.
The even more challenging thing about some of these patients is that they can have an entirely normal blood count, but a JAK2 mutation and a clot. So, it’s a very, very unique subgroup. So, we presented the approach to diagnosis and management of those patients as well. And there’s information being presented tomorrow about the molecular profile of these patients. How do we assess their prognosis? I think that’s an important abstract, because for some of the patients the biggest issue will be that clotting event and its consequences in the future. For other patients, there’s the clotting event, but there may be other mutations that can affect their prognosis as well.
When I listen to all this the two of you, and we’ll hear from Angela in a minute, you know, so ET is not the same in everyone. PV is not the same in everyone. MF is not the same in everyone. Increasingly, we need this understanding of your specific situation whether it’s genomically, whether there’s some other workup you need to do. And I would imagine with the group you were just talking about people getting the right diagnosis. I mean they finally get to you, thank God, but how long did it take them to get to that point?
Yeah, that’s an excellent point. Thrombotic events or clotting events are often the presenting feature. But when we see these patients, when we look back at the charts it’s oftentimes that we’ll see abnormal blood counts for a couple of years. So, I think we may make the diagnosis as hematologists, but the illness could have been present for years preceding, So, part of it is to try to educate primary care providers about looking at blood counts and knowing which ones should prompt a referral early versus which one is probably okay to watch. So, it’s a good point about awareness.
Would LDH be one of the ones that would trigger a workup?
Not necessarily. I think LDH worries hematologists a lot, but I think you can go back even further and just look at the platelet count or the red cell count. I mean some of those abnormalities are seemingly subtle, but when we see these patients they’ve often been present for years trending.
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