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Title:	Antiplatelet therapy versus observation in low-risk essential thrombocythemia with CALR mutation
Author:	Álvarez Larrán, Alberto; Pereira Saavedra, Arturo; Guglielmelli, Paola; Hernández Boluda, Juan Carlos; Arellano Rodrigo, Eduardo; Ferrer Marín, Francisca; Samah, Alimam; Griesshammer, Martin; Kerguelen Fuentes, Ana; Andreasson, Bjorn; Burgaleta, Carmen; Schwarz, Jiri; García Gutiérrez, Valentín; Ayala, Rosa; Barba, Pere; Gómez Casares, María Teresa; Paoli, Chiara; Drexler, Beatrice; Zweegman, Sonja; McMullin, Mary F.; Samuelsson, Jan; Harrison, Claire N.; Cervantes Requena, F.; Vannucchi, Alessandro M.; Besses, Carlos
Notes:	The role of antiplatelet therapy as primary prophylaxis of thrombosis in low-risk essential thrombocythemia has not been studied in randomized clinical trials. We assessed the benefit/risk of lowdose aspirin in 433 patients with low-risk essential thrombocythemia (271 with a CALR mutation, 162 with a JAK2V617F mutation) who were on antiplatelet therapy or observation only. After a follow up of 2215 person- years free from cytoreduction, 25 thrombotic and 17 bleeding episodes were recorded. In CALR-mutated patients, antiplatelet therapy did not affect the risk of thrombosis but was associated with a higher incidence of bleeding (12.9 versus 1.8 episodes per 1000 patient-years, P=0.03). In JAK2V617F-mutated patients, low-dose aspirin was associated with a reduced incidence of venous thrombosis with no effect on the risk of bleeding. Coexistence of JAK2V617F-mutation and cardiovascular risk factors increased the risk of thrombosis, even after adjusting for treatment with low-dose aspirin (incidence rate ratio: 9.8; 95% confidence interval: 2.3-42.3; P=0.02). Time free from cytoreduction was significantly shorter in CALR-mutated patients with essential thrombocythemia than in JAK2V617F-mutated ones (median time 5 years and 9.8 years, respectively; P=0.0002) and cytoreduction was usually necessary to control extreme thrombocytosis. In conclusion, in patients with low-risk, CALR-mutated essential thrombocythemia, low-dose aspirin does not reduce the risk of thrombosis and may increase the risk of bleeding.
Subject(s):	-Trombosi -Plaquetes sanguínies -Malalties hematològiques -Thrombosis -Blood platelets -Hematologic diseases
Rights:	(c) Ferrata Storti Foundation, 2016
Document type:	Article Article - Published version
Published by:	Ferrata Storti Foundation
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