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Thrombosis Prophylaxis in Myeloproliferative Disorders Assessed by Thromboelastography

Thrombosis Prophylaxis in Myeloproliferative Disorders Assessed by Thromboelastography. A. Braester, R. Nitzan-Inbar, L. Akria, A.Kuperman Institute of Hematology Western Galilee Hospital Nahariya, Israel. Thrombosis in MPD - Prophylaxis of thrombosis in MPD – ECLAP study

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Thrombosis Prophylaxis in Myeloproliferative Disorders Assessed by Thromboelastography

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  1. Thrombosis Prophylaxis in Myeloproliferative Disorders Assessed by Thromboelastography A. Braester, R. Nitzan-Inbar, L. Akria, A.Kuperman Institute of Hematology Western Galilee Hospital Nahariya, Israel

  2. Thrombosis in MPD - Prophylaxis of thrombosis in MPD – ECLAP study • What is thromboelastography? - The efficiency of TEG to assess the need of aspirin in PV.

  3. Thrombosis in PV/ET Thombotic complications characterize the clinical course of PV/ET and represent the main cause of morbidity and mortality. The problem of “benefit/risk” aspirin prophylaxis. The rationale: Platelet biosynthesis of thromboxane A2 is increased and can be suppresed by aspirin.

  4. Mechanism of thrombosis in MPD Age, thrombotic history and treatment Blood hyperviscosity High platelet count (?) Platelet abnormalities (qualitative) Increased thromboxane A2 production Proliferative activity of the disease (increased production of prothrombotic cells / substances). Thrombophilia Cardiovascular: HT, smocking, hypercholesterol. JAK2 V617F

  5. Thrombosis in MPD - Prophylaxis of thrombosis in MPD – ECLAP study

  6. European Collaboration on Low-dose Aspirin in PVECLAP a. Major thrombosis occurred in 3 per 100 patients/year. b. High plt biosynthesis of thromboxane A2 can be suppressed by low-dose aspirin. c. 518 pts enroled; follow-up 3-4 years. d. treatment with aspirin reduced the risk of major thromboses. e.CONCLUSION: low-dose aspirin can safetely prevent thrombotic complications in PV.

  7. Thrombosis in MPD - Prophylaxis of thrombosis in MPD – ECLA study • What is thromboelastography?

  8. TEG Provides comprehensive clotting profile analysis as it measures initial clot formation time, time to maximum clot, clot speed, clot strength and fibrinolysis. TEG can foresee the thrombotic potential in certain situations.

  9. Thrombosis in MPD - Prophylaxis of thrombosis in MPD – ECLA study • What is thromboelastography? - The efficiency of TEG to assess the need of aspirin in PV.

  10. Methods: Patients suffering from PV or ET were enrolled and a TEG analysis of the platelets was performed. Time, rate, strength and stability of the clot predicts if this clot will be able to complete a normal process of hemostasis. Maximum amplitude (MA) registered from the TEG tracing is a direct function of the platelets bonding via GP IIb/IIIa to fibrin, through platelet aggregation, clot strengthening and fibrin cross linkage. With the help of TEG we can see in all patients, including those who are on Aspirin, if this prophylaxis is warranted.

  11. Results: We found patients on Aspirin who are resistant to this medication and are at high risk for thrombosis (MA more than upper limit of normal); we also found patients receiving Aspirin without a real need for this prophylaxis (MA normal, without a risk for thrombosis); we found patients treated with Hydrea but not with Aspirin who need prophylaxis (MA more than upper normal limit) or are not in need of prophylaxis (MA less than upper limit of normal).

  12. Conclusions: TEG is an important test to determine the risk of thrombosis and the need for prophylaxis and to detect the patients resistant to Aspirin.

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