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Incidence and risk factors of hemorrhagic events in essential thrombocythemia

Feb 2, 2024
Learning objective: After reading this article, learners will be able to cite both the incidence and risk factors associated with hemorrhagic events in patients with essential thrombocythemia.

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Patients diagnosed with essential thrombocythemia (ET) experience thrombocytosis and risk reduction is therefore a key goal for therapeutic intervention. Currently, the main risk stratification model as recommended by the European LeukemiaNet is the International Prognostic Score of thrombosis in ET (IPSET-t); however, to date there has been no specific tool developed to aid in the prediction of hemorrhagic risk. Below, we summarize a publication from Tosoni et al. in Annals of Hematology on a retrospective analysis to define both the incidence and risk factors connected to hemorrhagic events in patients with ET.

Study design1

  • Included 308 ET patients diagnosed between 1996–2022
  • The primary study endpoint was the incidence of thrombotic and hemorrhagic vascular events linked with possible correlations between associated clinical variables and their occurrence.


Thrombotic events

  • More patients experienced thrombotic events during the course of ET compared with diagnosis (10.4% vs 6.2%).
  • More patients who experienced thrombosis had a high-risk IPSET-t score compared with patients who were high-risk but had no thrombosis at diagnosis (95% vs 47%, p < 0.001).
  • No correlation was found between mutational status and thrombotic risk.

Hemorrhagic events

  • A total of 40 hemorrhagic events were experienced by 35 patients.
  • Risk of hemorrhagic event was increased:
    • in patients at an older age (60) at diagnosis by 2.5-fold after diagnosis vs younger patients (p = 0.032); and
    • in patients with a high-risk IPSET-t score by 4.2-fold after diagnosis vs low/intermediate risk (p = 0.003).
  • The 10- and 20-year cumulative incidence of hemorrhagic events were 6% and 12%, respectively.
  • Hemorrhage-free survival was lower in high-risk IPSET-t patients vs low/intermediate risk (p = 0.002).
  • There was no correlation between incidence of hemorrhagic risk, driver mutation, and Janus kinase 2 variant allele frequency.

Key learnings

  • Highlight the potential use of the IPSET-t model as a global evaluator for vascular events.
  • Limited by its retrospective nature, cohort heterogeneity and small patient number.
  • Future studies should aim to analyze bleeding factors in larger and more homogenous patient cohorts alongside common bleeding classifications to help manage the increased risk of mortality as a result of thrombotic events.

  1. Tosoni L, Liberi M, Morelli G, et al. Correlation between IPSET‑t risk at diagnosis and subsequent hemorrhage in patients with essential thrombocythemia; a single institution experience. Ann of Haem. 2024;103(2):443–448. DOI: 1007/s00277-023-05578-8


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