bl-4162a has been researched along with Hemorrhage* in 25 studies
10 review(s) available for bl-4162a and Hemorrhage
Article | Year |
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Anagrelide compared with hydroxyurea in essential thrombocythemia: a meta-analysis.
Cytoreductive therapy, with or without low-dose aspirin, is the mainstay of thrombotic risk reduction in patients with essential thrombocythemia (ET), but the optimal choice of agent remains unclear. The aim of this study was to meta-analyze currently available data comparing anagrelide to hydroxyurea for reduction of rates of thrombosis, bleeding and death among patients with ET. A literature search for randomized, controlled trials comparing anagrelide to hydroxyurea among patients with ET revealed two published studies. Statistical analysis was performed using fixed effects meta-analysis. Rates of thrombosis were similar between patients treated with hydroxyurea vs anagrelide (RR 0.86, 95 % CI 0.64-1.16). Rates of major bleeding were lower in patients treated with hydroxyurea (RR 0.37, 95 % CI 0.18-0.75). Rates of progression to acute myeloid leukemia were not statistically different (RR 1.50, 95 % CI 0.43-5.29). The composite of thrombosis, major bleeding and death favored hydroxyurea (RR 0.78, 95 % CI 0.63-0.97). In conclusion, our analysis supports use of hydroxyurea as a first-line cytoreductive agent for patients with ET, based largely on decreased rates of major bleeding. Anagrelide appears to be equally effective for protection against thrombotic events and may be an appropriate alternative for patients who are intolerant of hydroxyurea. Topics: Hemorrhage; Humans; Hydroxyurea; Quinazolines; Thrombocythemia, Essential; Thrombosis | 2015 |
[Treatment of essential thrombocythemia].
Essential thrombocythemia is a chronic myeloproliferative neoplasm characterized by sustained thrombocytosis, bone marrow megakaryocytic hyperplasia and an increased risk of thrombosis and hemorrhage. The goal of treatment is to prevent the development of vascular complications without increasing the risk of transformation. Patients aged>60 years or a history of thrombosis have a high risk of thrombosis while those with a platelet count>1,500 x 10(9)/l have a higher risk of hemorrhage. Patients with low-risk essential thrombocythemia can be managed appropriately with low-dose of acetylsalicylic acid or even observation only, while patients with a high-risk disease are candidates to receive cytoreductive treatment, hydroxyurea being the first choice therapy. Anagrelide is the most suitable option for patients with resistance or intolerance to hydroxyurea. All patients must be submitted to a rigorous control of cardiovascular risk factors. Topics: Adult; Age Factors; Aged; Anticoagulants; Aspirin; Cell Transformation, Neoplastic; Disease Progression; Female; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Hydroxyurea; Intraoperative Complications; Janus Kinase 2; Leukemia, Myeloid, Acute; Life Expectancy; Male; Middle Aged; Mutation, Missense; Platelet Aggregation Inhibitors; Point Mutation; Pregnancy; Pregnancy Complications, Hematologic; Primary Myelofibrosis; Quinazolines; Risk Factors; Thrombocythemia, Essential; Thrombophilia | 2013 |
Paediatric essential thrombocythaemia: clinical and molecular features, diagnosis and treatment.
The incidence of essential thrombocythaemia (ET) in children (age ≤18 years) is extremely low. The natural course of the disorder in children has not been clarified. The rarity of patients and the variability of tested parameters make it difficult to draw any definitive conclusion in pathogenesis and diagnosis of paediatric ET. What makes the onset of thrombocytosis earlier in children is still uncertain. A diagnostic algorithm for paediatric ET has not been established, and current risk stratification used to guide therapeutic decisions in adults has not been validated in children. Vascular complications and transformation to myelofibrosis and leukaemia in this special entity have been reported, suggesting that ET in children is not an entirely benign disease. The crucial question is how to identify patients who are at high risk of complications and need treatment. There are insufficient data to recommend a specific agent in children. The purpose of this review is to outline the most recent progress in paediatric ET and to help with understanding the clinical course, molecular features, diagnosis and treatment strategies in this special group. Topics: Adolescent; Age of Onset; Anticoagulants; Child; Child, Preschool; Clone Cells; Disease Progression; GPI-Linked Proteins; Hemorrhage; Humans; Hydroxyurea; Incidence; Infant; Isoantigens; Janus Kinase 2; Leukemia, Myeloid, Acute; Platelet Aggregation Inhibitors; Point Mutation; Primary Myelofibrosis; Quinazolines; Receptors, Cell Surface; Risk Assessment; Symptom Assessment; Thrombocythemia, Essential; Thrombophilia | 2013 |
[Management of patients with essential thrombocythemia].
Topics: Adult; Aged; Bone Marrow; Cytostatic Agents; Disease Management; Female; Genetic Predisposition to Disease; Hemorrhage; Humans; Interferon-alpha; Janus Kinase 2; Lactation; Male; Middle Aged; Platelet Aggregation Inhibitors; Point Mutation; Pregnancy; Pregnancy Complications, Hematologic; Quinazolines; Thrombocythemia, Essential; Thrombophilia | 2013 |
Anagrelide: what was new in 2004 and 2005?
Anagrelide is an established platelet-reducing drug. Although there are gaps in the understanding of its mechanism of action, two randomized comparisons with other drugs used for therapy of patients with essential thrombocythemia (ET) have been performed. Recent progress has been made in this field with the development of better determination techniques, with the characterization of metabolites, and with studies of their mechanism of action on megakaryocytes and platelets. More data are now available from various noncomparative clinical trials on its clinical efficacy and safety. Only few investigations are available that document its long-term effects. Although the drug should not be used during pregnancy, there are a few studies that report that pregnant women have taken this drug without harm to the newborn. Studies have also investigated the effects of anagrelide on platelets, indicating that platelet function is as important as platelet counts in ET. Preliminary analyses of the mechanism of action of anagrelide have revealed that the drug interferes with the signal transduction of the thrombopoietin receptor. Results of the first phase III trial (PT1) that compared anagrelide/aspirin with hydroxyurea/aspirin have sparked an intense discussion, given that the combination of anagrelide and aspirin causes more bleeding complications in the gastrointestinal tract. It has been speculated that the higher number of transient ischemic attacks in this study arm is not caused by thrombotic events but by small bleedings that would be responsible for transient hemorrhagic attacks. More insights are expected from the recently completed ANAHYDRET trial that compared monotherapy with hydroxyurea and anagrelide. Topics: Antineoplastic Agents; Aspirin; Blood Platelets; Clinical Trials, Phase III as Topic; Drug Therapy, Combination; Female; Fibrinolytic Agents; Hemorrhage; History, 21st Century; Humans; Hydroxyurea; Male; Megakaryocytes; Platelet Aggregation Inhibitors; Pregnancy; Pregnancy Complications, Hematologic; Quinazolines; Randomized Controlled Trials as Topic; Signal Transduction; Thrombocythemia, Essential | 2006 |
Update on diagnosis and management of essential thrombocythemia.
Patients with essential thrombocythemia carry a high risk for thromboembolic and bleeding events but they have an almost normal life expectancy. A careful evaluation of the medical history and an exact diagnosis is mandatory to estimate each patient's risk for morbidity and to choose the most appropriate treatment measure. In patients with the need of cytoreductive therapy, the benefits of therapy have to outweigh the potential risks of drug toxicities. Hydroxyurea is the most useful cytoreductive drug for elderly patients; in younger persons, interferon alpha or anagrelide may be the drugs of choice. The combination of anagrelide with acetylsalicylic acid may be contraindicated in patients with a history of bleeding. Topics: Age Factors; Antineoplastic Agents; Aspirin; Drug Antagonism; Female; Fibrinolytic Agents; Hemorrhage; Humans; Hydroxyurea; Interferon-alpha; Life Expectancy; Male; Quinazolines; Risk Factors; Thrombocythemia, Essential | 2006 |
[Treatment of essential thrombocythemia].
Essential thrombocythemia (ET) is a myeloproliferative syndrome that rises many therapeutic problems. This affection is rarely life threatening, but hemorrhagic and thrombotic complications must be prevented when possible. The rarity of these complications makes difficult the assessment of treatment efficiency. Few randomised clinical trials were done, and treatment often rests on retrospective studies. The potential toxicity of treatments, their leukemogenicity in particular, rises a decisional problem for young patients. We propose to review available data in order to propose the most rational treatment for each patient.. After numerous years when we only disposed of retrospective studies, non-randomised prospective studies or isolated case-reports, two randomised trials allows us to more precisely define ET treatment. The first trial proved the efficiency of the hydroxyurea-aspirin association in the prevention of thrombotic events in high-risk patients. The second trial signalled to our attention the increased risk of bleeding of the association anagrelide-aspirin, with also the possibility of increased appearance of myelofibrosis.. New perspectives in the treatment of ET will require to get more insights in the role of hydroxyurea and anagrelide in particular by longer follow-up. But not less important is a better definition of the thrombosis risks (who has to be treated?) and also of the diagnostic groups since ET can, in some particular cases, be misdiagnosed with polycythemia vera or idiopathic myelofibrosis. Topics: Aspirin; Enzyme Inhibitors; Hemorrhage; Humans; Hydroxyurea; Immunologic Factors; Interferon-alpha; Platelet Aggregation Inhibitors; Quinazolines; Randomized Controlled Trials as Topic; Risk Factors; Thrombocythemia, Essential | 2005 |
The pathogenesis and management of essential thrombocythaemia.
Topics: Acute Disease; Alkylating Agents; Aspirin; Cardiovascular Diseases; Clone Cells; Gene Expression; Hemorrhage; Humans; Hydroxyurea; Leukemia, Myeloid; Megakaryocytes; Platelet Aggregation Inhibitors; Quinazolines; Risk; Thrombocythemia, Essential; Thrombophilia | 1999 |
Treatment of polycythaemia vera and essential thrombocythaemia.
The clinical course in both polycythaemia vera (PV) and essential thrombocythaemia (ET) is characterized by significant thrombohaemorrhagic complications and variable risk of disease transformation into myeloid metaplasia with myelofibrosis or acute myeloid leukaemia. Randomized studies have shown that the risk of thrombosis was significantly reduced in ET with the use of hydroxyurea (HU) and in PV with the use of chlorambucil or 32P. However, the use of chlorambucil or 32P has been associated with an increased risk of leukaemic transformation. Subsequently, other studies have suggested that both HU and pipobroman may be less leukaemogenic and as effective as chlorambucil and 32P for preventing thrombosis in PV. However, the results from these prospective studies have raised concern that even HU and pipobroman may be associated with excess leukaemic events in both ET and PV. The recent introduction of anagrelide as a specific platelet-lowering agent, the demonstration of treatment efficacy with interferon-alpha, and the revived interest in using low-dose acetylsalicylic acid provide the opportunity to initiate prospective randomized studies incorporating these treatments. Topics: Adult; Aged; Aspirin; Chlorambucil; Disease Progression; Female; Hemorrhage; Humans; Hydroxyurea; Interferon-alpha; Leukemia, Myeloid; Leukemia, Radiation-Induced; Male; Middle Aged; Phlebotomy; Phosphorus Radioisotopes; Pipobroman; Polycythemia Vera; Primary Myelofibrosis; Prospective Studies; Quinazolines; Thrombocythemia, Essential; Thrombosis | 1998 |
Treatment strategies in essential thrombocythemia. A critical appraisal of various experiences in different centers.
The therapeutic strategy in patients with Essential Thrombocythemia (ET) is a difficult balance between the prevention of bleeding and thrombotic complications and the risks of drug side effects and toxicity. Major bleeding is rare and seem to be related to higher platelet counts: therefore, a platelet count over 1500 x 10(9)/L is generally regarded as an indication for cytoreduction. Thrombotic complications include microvascular occlusive symptoms, which are reversible with low-dose aspirin, and large vessels thrombosis. The risk of major thrombosis is higher in ET patients aged more than 60 ys. and with previous occlusive event. In this high-risk group, the non-alkylating agent hydroxyurea (HU) significantly reduces the rate of vascular complications and has emerged as the treatment of choice. However, the long-term risk/benefit of HU remains disputed because its leukemogenic potential has not been ruled out. This holds also for other myelosuppressive agents, such as busulphan and pipobroman. Other drugs of particular interest for young patients include recombinant alpha-interferon (IFN) and Anagrelide. Both of them are effective in lowering platelet count, but their efficacy in reducing clinical complications remains to be demonstrated. However, both IFN and Anagrelide have shown to have frequent and clinically important side effects. Thus, further clinical studies are required to establish their role in the strategy of ET patient treatment. Topics: Adult; Aged; Alkylating Agents; Anemia, Megaloblastic; Arrhythmias, Cardiac; Bone Marrow Diseases; Busulfan; Female; Hemorrhage; Humans; Hydroxyurea; Immunologic Factors; Incidence; Interferon-alpha; Ischemic Attack, Transient; Leukemia; Male; Middle Aged; Pipobroman; Platelet Aggregation Inhibitors; Platelet Count; Prognosis; Quinazolines; Risk Factors; Thrombocythemia, Essential; Thrombosis | 1996 |
5 trial(s) available for bl-4162a and Hemorrhage
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Reticulin accumulation in essential thrombocythemia: prognostic significance and relationship to therapy.
Essential thrombocythemia (ET) manifests substantial interpatient heterogeneity in rates of thrombosis, hemorrhage, and disease transformation. Bone marrow histology reflects underlying disease activity in ET but many morphological features show poor reproducibility.. We evaluated the clinical significance of bone marrow reticulin, a measure previously shown to have relatively high interobserver reliability, in a large, prospectively-studied cohort of ET patients.. Reticulin grade positively correlated with white blood cell (P = .05) and platelet counts (P = .0001) at diagnosis. Elevated reticulin levels at presentation predicted higher rates of arterial thrombosis (hazard ratio [HR], 1.8; 95% CI, 1.1 to 2.9; P = .01), major hemorrhage (HR, 2.0; 95% CI, 1.0 to 3.9; P = .05), and myelofibrotic transformation (HR, 5.5; 95% CI, 1.7 to 18.4; P = .0007) independently of known risk factors. Higher reticulin levels at diagnosis were associated with greater subsequent falls in hemoglobin levels in patients treated with anagrelide (P < .0001), but not in those receiving hydroxyurea (P = .9). Moreover, serial trephine specimens in patients randomly assigned to anagrelide showed significantly greater increases in reticulin grade compared with those allocated to hydroxyurea (P = .0003), and four patients who developed increased bone marrow reticulin on anagrelide showed regression of fibrosis when switched to hydroxyurea. These data suggest that patients receiving anagrelide therapy should undergo surveillance bone marrow biopsy every 2 to 3 years and that those who show substantially increasing reticulin levels are at risk of myelofibrotic transformation and may benefit from changing therapy before adverse clinical features develop.. Our results demonstrate that bone marrow reticulin grade at diagnosis represents an independent prognostic marker in ET, reflecting activity and/or duration of disease, with implications for the monitoring of patients receiving anagrelide. Topics: Biomarkers; Bone Marrow; Hemoglobins; Hemorrhage; Humans; Hydroxyurea; Leukocyte Count; Platelet Aggregation Inhibitors; Platelet Count; Primary Myelofibrosis; Prognosis; Prospective Studies; Quinazolines; Reticulin; Thrombocythemia, Essential; Thrombosis | 2009 |
Effect of anagrelide on platelet coagulant function in patients with essential thrombocythemia.
Topics: Adult; Aged; Antithrombin III; Aspirin; Drug Therapy, Combination; Female; Fibrin Fibrinogen Degradation Products; Hemorrhage; Humans; Hydroxyurea; Male; Middle Aged; Peptide Fragments; Peptide Hydrolases; Platelet Activation; Platelet Aggregation Inhibitors; Platelet Count; Platelet Factor 4; Prothrombin; Quinazolines; Thrombocythemia, Essential; Thrombosis | 2007 |
Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia.
We conducted a randomized comparison of hydroxyurea with anagrelide in the treatment of essential thrombocythemia.. A total of 809 patients with essential thrombocythemia who were at high risk for vascular events received low-dose aspirin plus either anagrelide or hydroxyurea. The composite primary end point was the actuarial risk of arterial thrombosis (myocardial infarction, unstable angina, cerebrovascular accident, transient ischemic attack, or peripheral arterial thrombosis), venous thrombosis (deep-vein thrombosis, splanchnic-vein thrombosis, or pulmonary embolism), serious hemorrhage, or death from thrombotic or hemorrhagic causes.. After a median follow-up of 39 months, patients in the anagrelide group were significantly more likely than those in the hydroxyurea group to have reached the primary end point (odds ratio, 1.57; 95 percent confidence interval, 1.04 to 2.37; P=0.03). As compared with hydroxyurea plus aspirin, anagrelide plus aspirin was associated with increased rates of arterial thrombosis (P=0.004), serious hemorrhage (P=0.008), and transformation to myelofibrosis (P=0.01) but with a decreased rate of venous thromboembolism (P=0.006). Patients receiving anagrelide were more likely to withdraw from their assigned treatment (P<0.001). Equivalent long-term control of the platelet count was achieved in both groups.. Hydroxyurea plus low-dose aspirin is superior to anagrelide plus low-dose aspirin for patients with essential thrombocythemia at high risk for vascular events. Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Aspirin; Drug Therapy, Combination; Female; Follow-Up Studies; Hemorrhage; Humans; Hydroxyurea; Leukemia, Myeloid, Acute; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Count; Primary Myelofibrosis; Quinazolines; Thrombocythemia, Essential; Thrombosis | 2005 |
Anagrelide treatment in 52 patients with chronic myeloproliferative diseases.
In this retrospective multi-centre study, we report our experience with anagrelide in the treatment of thrombocytosis in patients with chronic myeloproliferative diseases. Our study included 52 patients (age 20-78 years). The initial anagrelide dose was, in general, 0.5 mg once daily and mean maintenance dosage was 1.7 mg/day. The overall response rate was 79% including 75% complete remission and 4% partial remission. Forty-two patients (81%) had adverse effects and in 29% of the study population, the adverse effects necessitated cessation of anagrelide. The most common adverse effect was moderate anaemia (50%). Two patients experienced erectile dysfunction which has been described only once previously in association with anagrelide treatment. One patient progressed to acute leukaemia. However, this patient had been pre-treated with two potentially leukaemogenic drugs and had only been in short-term treatment with anagrelide. Furthermore, a total of 13 events were recorded. More than 25% of these events occurred in patients with platelet counts between 400 and 600 x 10(9)/l and almost 40% of all events occurred in patients with platelet counts above 400 x 10(9)/l. This observation supports the hypothesis that aggressive control of thrombocytosis to a platelet count <400 x 10(9)/l might reduce the number of thrombohaemorrhagic events. Anagrelide is safe and effective in reducing the platelet counts, but a high proportion of the patients discontinue treatment because of the adverse effects of the drug. Topics: Adult; Aged; Anemia; Chronic Disease; Female; Hemorrhage; Humans; Male; Middle Aged; Myeloproliferative Disorders; Platelet Aggregation Inhibitors; Quinazolines; Retrospective Studies; Thrombocytosis; Thromboembolism; Treatment Outcome | 2004 |
Effectiveness of anagrelide in the treatment of symptomatic patients with essential thrombocythemia.
We prospectively evaluated the effect of anagrelide on platelet counts and the clinical manifestations of microvascular circulation disturbances in 17 newly diagnosed patients with essential thrombocythemia. Ten patients had symptoms related to thrombocythemia, eight at the time of starting anagrelide treatment. The platelet counts before anagrelide treatment and during maintained remission of essential thrombocythemia by anagrelide were 980 (range, 610-2030) and 378 (range, 212-546) x 10(9)/L, respectively. Spontaneous platelet aggregation was found in 6 patients (35%), which disappeared on remission of essential thrombocythemia in five cases (P = 0.02). Essential thrombocythemia-related microvascular thrombotic and hemorrhagic symptoms disappeared with the normalization of platelet count in all cases during maintained remission of essential thrombocythemia by long term continuous anagrelide treatment with a follow-up period of between 2 and 6 years. However, ET-related symptoms reappeared in three patients, coinciding with increased platelet count up to 600 x 10(9)/L caused by anagrelide dose reduction. We conclude that reduction of increased platelet to normal (< 400 x 10(9)/L) in symptomatic patients with essential thrombocythemia through use of maintained anagrelide treatment is associated with the disappearance of spontaneous platelet aggregation and the complete relief of thrombotic and hemorrhagic manifestations. Topics: Adult; Aged; Female; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Count; Quinazolines; Thrombocytosis | 2000 |
10 other study(ies) available for bl-4162a and Hemorrhage
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Review of the risk of thrombosis or bleeding upon abrupt anagrelide discontinuation in patients with essential thrombocythemia.
Topics: Hemorrhage; Humans; Platelet Aggregation Inhibitors; Quinazolines; Thrombocythemia, Essential; Thrombosis | 2022 |
Clinical Features of 294 Turkish Patients with Chronic Myeloproliferative Neoplasms.
Myeloproliferative neoplasms (MPNs) share common clonal stem cells but show significant differences in their clinical courses. The aim of this retrospective study was to evaluate thrombotic and hemorrhagic complications, JAK2 status, gastrointestinal and cardiac changes, treatment modalities, and survival in MPNs in Turkish patients.. Medical files of 294 patients [112 essential thrombocythemia (ET), 117 polycythemia vera (PV), 46 primary myelofibrosis, and 19 unclassified MPN cases] from 2 different universities in Turkey were examined.. Older age, higher leukocyte count at diagnosis, and JAK2 mutation positivity were risk factors for thrombosis. Platelet count over 1000x109/L was a risk factor for hemorrhagic episodes. Hydroxyurea treatment was not related to leukemic transformation. Median follow-up time was 50 months (quartiles: 22.2-81.75) in these patients. Patients with primary myelofibrosis had the shortest survival of 137 months when compared with 179 months for ET and 231 months for PV. Leukemic transformation, thromboembolic events, age over 60 years, and anemia were found to be the factors affecting survival.. Thromboembolic complications are the most important preventable risk factors for morbidity and mortality in MPNs. Drug management in MPNs is done according to hemoglobin and platelet counts. Based on the current study population our results support the idea that leukocytosis and JAK2 positivity are more important risk factors for thrombosis than hemoglobin and platelet values.. Amaç: Miyeloproliferatif hastalıklar (MPH) ortak klonal bir kök hücreden köken almalarına karşın klinik seyirleri belirgin farklılıklar göstermektedir. Bu retrospektif çalışmanın amacı MPH’lardaki trombotik ve hemorajik komplikasyonların, JAK2 mutasyon durumunun, gastrointestinal ve kardiyak değişikliklerin, tedavi şekillerinin ve yaşam sürelerinin incelenmesidir. Gereç ve Yöntemler: Türkiye’nin iki farklı üniversite hastanesinden 294 hastanın [112 esansiyel trombositemi (ET), 117 polisitemia vera (PV), 46 primer miyelofibozis, 19 sınıflanamayan MPH] kayıtları incelenmiştir. Bulgular: İleri yaş, tanıda yüksek lökosit sayısı JAK2 mutasyon pozitifliği tromboz için risk faktörü olarak bulunmuştur. Trombosit sayımının 1000x109/L üzerinde olması kanama komplikasyonları açısından risk faktörüdür. Hidroksiüre tedavisi lösemik dönüşümle ilişkili bulunmamıştır. Bu hastalarda: Medyan takip süresi 50 ay (22,2-81,75 çeyrekler) idi. Primer miyelofibrozisli hastalar ET için 179 ay ve PV için 231 ay olan yaşam süreleri ile karşılaştırıldığında 137 ay ile en kısa yaşam süresine sahip hastalardır. Lösemik transformasyon, tromboembolik olaylar, 60 yaş üstü olmak ve anemi yaşam süresinin etkileyen faktörler olarak bulunmuştur. Sonuç: Tromboembolik komplikasyonlar MPH’da en önemli önlenebilir mortalite ve morbidite nedenidir. İlaç düzenlemeleri çoğunlukla hemoglobin ve trombosit sayımlarına göre yapılmaktadır. Bu çalışmamızdaki hasta popülasyonundan elde ettiğimiz veriler lökositoz ve JAK2 pozitifliğinin hemoglobin ve trombosit sayımlarından daha önemli risk faktorleri olduğu savını desteklemektedir. Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Hemorrhage; Humans; Hydroxyurea; Janus Kinase 2; Male; Middle Aged; Mutation; Myeloproliferative Disorders; Quinazolines; Retrospective Studies; Risk Factors; Turkey; Venous Thromboembolism; Young Adult | 2016 |
Prediction of thrombotic and hemorrhagic events during polycythemia vera or essential thrombocythemia based on leukocyte burden.
Evidences suggest an association between leukocytosis and thrombotic or hemorrhagic complication in polycythemia vera (PV) and essential thrombocythemia (ET), but clinical implication is not well known.. To evaluate whether leukocyte burden during follow-up is related to thrombotic or hemorrhagic events in PV and ET.. We retrospectively analyzed patients with PV or ET treated at Seoul National University Bundang Hospital, Korea. Time-weighted averages of leukocytes during the follow-up period were defined as leukocyte burden and were calculated for each patient and compared between patient subgroups. In each patient with events, leukocyte burden for the 3-month period before the event was compared with that for the entire follow-up period.. In 102 patients with PV or ET, 35 events (16 thrombotic, 19 hemorrhagic) occurred in 29 patients (median follow-up, 54months). Leukocyte burden were significantly higher in patients with events than in event-free patients (12,015×10(3) /μL vs. 9,567×10(3)/μL, P=0.003). The difference was more prominent in ET patients than in PV patients, and in patients with hemorrhagic events than in those with thrombotic events. In patients with events, the leukocyte burden in the pre-event period was higher than in the entire follow-up period (16,767×10(3)/μL vs. 12,015×10(3)/μL, P=0.002). In all patients, leukocyte burden during entire follow-up period of 11,000×10(3)/μL or higher was an independent risk factor for vascular events.. In PV or ET patients, leukocyte burden during disease course is related to increased incidence of thrombotic or hemorrhagic events. Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Blood Cell Count; Comorbidity; Databases, Factual; Female; Follow-Up Studies; Hemorrhage; Hemorrhagic Disorders; Humans; Hydroxyurea; Leukocyte Count; Male; Middle Aged; Phlebotomy; Platelet Aggregation Inhibitors; Polycythemia Vera; Prognosis; Quinazolines; Retrospective Studies; Risk Factors; Thrombocythemia, Essential; Thrombophilia; Thrombosis; Young Adult | 2015 |
Successful management of acute bleeding in essential thrombocythemia using automated cell separator.
This case represents the challenging role of automated cell separators in management of acute hemorrhagic crisis in a young female patient of essential thrombocythemia. A 17 year old girl having body weight of 41 kg presented to us with profuse nasal bleed. Complete blood counts revealed extremely high platelet counts of 2987×10(9)/l. Due to no response by oral hydroxyurea for last 2 months, urgent mechanical platelet reduction was planned to prevent further complication. A rebound phenomenon of increase in circulating platelet count was observed after every therapeutic platelet reduction. Seven procedures had to be performed on alternate days to bring down the platelet counts to less than 600×10(9)/l. Patient was maintained on oral anagrelide therapy and discharged in a stable condition after 14 days. Therapeutic platelet reduction causes rapid platelet reduction and helps in managing acute complications. Topics: Administration, Oral; Adolescent; Automation; Blood Platelets; Body Weight; Cell Separation; Female; Hemorrhage; Humans; Hydroxyurea; Platelet Count; Quinazolines; Thrombocythemia, Essential; Thrombocytosis | 2014 |
Prophylaxis and management of venous thromboembolism in patients with myeloproliferative neoplasms: consensus statement of the Haemostasis Working Party of the German Society of Hematology and Oncology (DGHO), the Austrian Society of Hematology and Oncolo
Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) like polycythemia vera and essential thrombocythemia are at increased risk of arterial and venous thrombosis. Strategies of prevention may consist of platelet aggregation inhibitors and/or cytoreductive agents depending on the underlying disease and the individual risk. Clinical evidence for management of acute venous thromboembolic events in MPN patients is limited. Modality and duration of therapeutic anticoagulation after venous thrombosis has to be evaluated critically with special regard to the increased risk for spontaneous bleeding events associated with the underlying diseases. Both for therapy of the acute event and for secondary prophylaxis, low-molecular-weight heparins should preferentially be used. A prolongation of the therapeutic anticoagulation beyond the usual 3 to 6 months can only be recommended in high-risk settings and after careful evaluation of potential risks and benefits for the individual patient. New direct oral anticoagulants (NOAC) should not preferentially be used due to lack of clinical experience in patients with MPN and potential drug interactions (e.g. with JAK inhibitors). Consequent treatment of the underlying myeloproliferative disease and periodical evaluation of the response to therapy is crucial for optimal secondary prophylaxis of thromboembolic events in those patients. Topics: Anticoagulants; Disease Susceptibility; Drug Interactions; Female; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Hydroxyurea; Incidence; Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative; Male; Myeloproliferative Disorders; Phlebotomy; Platelet Aggregation Inhibitors; Postoperative Complications; Pregnancy; Pregnancy Complications, Hematologic; Preoperative Care; Protein Kinase Inhibitors; Quinazolines; Secondary Prevention; Thrombophilia; Venous Thromboembolism; von Willebrand Diseases | 2014 |
Bilateral adrenal hemorrhage associated with essential thrombocytosis.
Topics: Adrenal Insufficiency; Aged; Hemorrhage; Humans; Magnetic Resonance Imaging; Male; Quinazolines; Thrombocythemia, Essential | 2006 |
When and how to treat essential thrombocythemia.
Topics: Antineoplastic Agents; Aspirin; Drug Therapy, Combination; Hemorrhage; Humans; Hydroxyurea; Leukemia, Myeloid, Acute; Platelet Aggregation Inhibitors; Primary Myelofibrosis; Quinazolines; Risk Factors; Thrombocythemia, Essential; Thrombosis | 2005 |
Efficacy and safety of long-term use of hydroxyurea in young patients with essential thrombocythemia and a high risk of thrombosis.
Topics: Adolescent; Adult; Anemia; Cohort Studies; Follow-Up Studies; Hemorrhage; Humans; Hydroxyurea; Incidence; Middle Aged; Quinazolines; Risk; Thrombocythemia, Essential; Thrombophilia; Thrombosis | 2003 |
Long-term use of anagrelide in young patients with essential thrombocythemia.
Anagrelide is a novel platelet-lowering agent that has recently been approved for use in essential thrombocythemia (ET) and related disorders. Short-term drug efficacy and toxicity data have previously been presented. The purpose of this study was to obtain additional information regarding long-term anagrelide use. This is a retrospective series of 35 young patients (17 to 48 years) with ET who received anagrelide treatment before 1992. Initial drug dosage ranged between 1 and 10 mg/d, and the median maintenance dosage was 2.5 mg/d. The overall initial response rate of 94% included 74% complete remissions and 20% partial remissions. Of the 33 responding patients, 27 (82%) remained on anagrelide therapy for a median of 10.8 years (range, 7 to 15.5). Of these, 66% maintained a complete and 34% a partial remission over the study period. In general, the reporting of somatic side effects decreased over time, and anemia was the only new side effect that emerged after long-term therapy. Eight patients (24%) experienced a more than 3 g/dL decrease in hemoglobin level. Despite active therapy, 20% of the patients experienced a total of 10 thrombotic episodes, and a similar proportion experienced major hemorrhagic events. All thrombohemorrhagic complications occurred at a platelet count of more than 400 x 10(9)/L. It is concluded that long-term treatment of ET with anagrelide is associated with decreased reporting of initial side effects and the development of mild-to-moderate anemia. Complete normalization of platelet counts may be needed to minimize residual thrombohemorrhagic risk during therapy. (Blood. 2001;97:863-866) Topics: Adolescent; Adult; Female; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Quinazolines; Remission Induction; Retrospective Studies; Thrombocythemia, Essential; Thrombosis; Treatment Outcome | 2001 |
A potent new inhibitor of platelet aggregation and experimental thrombosis, anagrelide (BL-4162A).
Topics: Adenosine Diphosphate; Animals; Carotid Arteries; Collagen; Dogs; Electricity; Fibrinolytic Agents; Haplorhini; Hemorrhage; Humans; Imidazoles; Lasers; Macaca mulatta; Platelet Aggregation; Quinazolines; Rabbits; Rats; Thrombosis | 1979 |