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Publications (5 of 5) Show all publications
Enblom-Larsson, A., Renlund, H., Andréasson, B., Holmberg, H., Liljeholm, M. & Själander, A. (2024). Thromboembolic events, major bleeding and mortality in essential thrombocythaemia and polycythaemia vera: a matched nationwide population-based study. British Journal of Haematology
Open this publication in new window or tab >>Thromboembolic events, major bleeding and mortality in essential thrombocythaemia and polycythaemia vera: a matched nationwide population-based study
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2024 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141Article in journal (Refereed) Epub ahead of print
Abstract [en]

Thromboembolic events and bleeding are known complications in essential thrombocythaemia (ET) and polycythaemia vera (PV). Using multiple Swedish health care registers, we assessed the rate of arterial and venous events, major bleeding, all-cause stroke and all-cause mortality in ET and PV compared to matched controls. For each patient with ET (n = 3141) and PV (n = 2604), five matched controls were randomly selected. In total, 327 and 405 arterial or venous events were seen in the group of ET and PV patients respectively. Compared to corresponding controls, the rate of venous thromboembolism, major bleeding and all-cause mortality per 100 treatment years was significantly increased among both ET (0.63, 0.79 and 3.70) and PV patients (0.94, 1.20 and 4.80). The PV patients also displayed a significantly higher rate of arterial events and all-cause stroke compared to controls. When dividing the cohort into age groups, we found a significantly higher rate of arterial and venous events in all age groups of PV patients, and the rate of all-cause mortality was significantly higher in both ET and PV patients in all ages above the age of 50. This study confirms that PV and ET are diseases truly marked by thromboembolic complications and bleeding.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
essential thrombocythaemia, polycythaemia vera, thrombosis (venous), thrombosis - arterial
National Category
Hematology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-221663 (URN)10.1111/bjh.19337 (DOI)38351734 (PubMedID)2-s2.0-85185487280 (Scopus ID)
Funder
The Swedish Stroke AssociationVisare Norr
Available from: 2024-03-04 Created: 2024-03-04 Last updated: 2024-03-04
Enblom, A., Andréasson, B., Holmberg, H., Liljeholm, M. & Själander, A. (2023). Erythrocytosis, thrombocytosis, and rate of recurrent thromboembolic event: a population based cohort study. European Journal of Haematology, 110(6), 608-617
Open this publication in new window or tab >>Erythrocytosis, thrombocytosis, and rate of recurrent thromboembolic event: a population based cohort study
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2023 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 110, no 6, p. 608-617Article in journal (Refereed) Published
Abstract [en]

Introduction: The management to reduce risk of thromboembolic complications in polycythemia vera and essential thrombocythemia are well established, but for other conditions with elevated hemoglobin, hematocrit, or platelets there are no consensus regarding treatment and follow up.

Aims: To assess frequency of elevated blood values in patients with thromboembolic event, how many of these should be investigated further regarding myeloproliferative neoplasm and if the risk of recurrent event is depending on underlying condition.

Methods: Retrospective cohort study of 3931 adult patients in the county of Norrbotten, Sweden, with thromboembolism during 2017 and 2018.

Results: Of the 3931 patients, 1195 had either elevated Hb, HCT, or platelets fulfilling the 2016 revised WHO criteria for PV and ET, and out of these 411 should be evaluated regarding underlying myeloproliferative neoplasms. Unexplained thrombocytosis and secondary erythrocytosis were associated with the highest rate of recurrent event as well as the most inferior restricted mean survival time.

Conclusion: Elevated blood values are common in patients with thromboembolic event and the high risk of recurrent event and inferior restricted mean survival time in patients with unexplained thrombocytosis and secondary erythrocytosis implicates the importance of finding and managing the underlying condition.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
essential thrombocythemia, polycythemia, polycythemia vera, thrombocytosis, thromboembolism
National Category
Hematology
Identifiers
urn:nbn:se:umu:diva-205189 (URN)10.1111/ejh.13938 (DOI)000932888700001 ()36725666 (PubMedID)2-s2.0-85147986248 (Scopus ID)
Funder
Norrbotten County Council
Available from: 2023-02-28 Created: 2023-02-28 Last updated: 2023-07-12Bibliographically approved
Lindgren, M., Andréasson, B., Samuelsson, J., Pettersson, H., Enblom, A., Ravn-Landtblom, A., . . . Ahlstrand, E. (2022). Survival and risk of vascular complications in myelofibrosis: a population-based study from the Swedish MPN group. European Journal of Haematology, 109(4), 336-342
Open this publication in new window or tab >>Survival and risk of vascular complications in myelofibrosis: a population-based study from the Swedish MPN group
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2022 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 109, no 4, p. 336-342Article in journal (Refereed) Published
Abstract [en]

Objective: To gain knowledge of underlying risk factors for vascular complications and their impact on life expectancy in myelofibrosis.

Methods: From a cohort of 392 myelofibrosis patients registered in the Swedish MPN registry 58 patients with vascular complications during follow-up were identified. Patients with vascular complications were compared with both 1:1 matched controls and the entire myelofibrosis cohort to explore potential risk factors for vascular complications and their impact on survival.

Results: Incidence of vascular complications was 2.8 events per 100 patient-years and the majority of complications were thrombotic. Patients with complications were significantly older and had lower hemoglobin when compared to the entire cohort. In the case–control analysis, no significant risk factor differences were observed. The major cause of death was vascular complications and median survival was significantly impaired in patients with vascular complications (48 months) compared to controls (92 months). Inferior survival in patients with vascular complications was found to be dependent on IPSS risk category in a Cox regression model.

Conclusion: Vascular complications have a considerable impact on survival in MF. At diagnosis, risk assessment by IPSS does not only predict survival but is also associated with the risk of vascular complications.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
IPSS, JAK2V617F, Myelofibrosis, myeloproliferative neoplasms, survival, vascular complications
National Category
Hematology
Identifiers
urn:nbn:se:umu:diva-197798 (URN)10.1111/ejh.13813 (DOI)000815366500001 ()35696444 (PubMedID)2-s2.0-85132576366 (Scopus ID)
Available from: 2022-07-05 Created: 2022-07-05 Last updated: 2023-05-23Bibliographically approved
Enblom, A., Girodon, F., Bak, M., Hersby, D., Jooste, V., Hasselbalch, H., . . . Andreasson, B. (2017). A retrospective analysis of the impact of treatments and blood counts on survival and the risk of vascular events during the course of polycythaemia vera. British Journal of Haematology, 177(5), 800-805
Open this publication in new window or tab >>A retrospective analysis of the impact of treatments and blood counts on survival and the risk of vascular events during the course of polycythaemia vera
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2017 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 177, no 5, p. 800-805Article in journal (Refereed) Published
Abstract [en]

Vascular and non-vascular complications are common in patients with polycythaemia vera. This retrospective study of 217 patients with polycythaemia vera aimed to determine whether blood counts with respect to different treatments influenced the complication rate and survival. We found that 78 (36%) patients suffered from at least one complication during follow-up. Older age and elevated lactate dehydrogenase at diagnosis were found to be risk factors for vascular complications. When the vascular complication occurred, 41% of the patients with a complication had elevated white blood cells (WBC) compared with 20% of patients without a complication (P = 0·042). Patients treated with hydroxycarbamide (HC; also termed hydroxyurea) experienced significantly fewer vascular complications (11%) than patients treated with phlebotomy only (27%) (P = 0·013). We also found a survival advantage for patients treated with HC, when adjusted for age, gender and time period of diagnosis (Hazard ratio for phlebotomy-treated patients compared to HC-treated patients at 5 years was 2·42, 95% confidence interval 1·03-5·72, P = 0·043). Concerning survival and vascular complications, HC-treated patients who needed at least one phlebotomy per year were not significantly different from HC-treated patients with a low phlebotomy requirement. We conclude that complementary phlebotomy in HC-treated patients in order to maintain the haematocrit, is safe.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
polycythaemia vera, myeloproliferative disease, hydroxycarbamide, venesection
National Category
Hematology
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-192763 (URN)10.1111/bjh.14625 (DOI)000402419700015 ()28474342 (PubMedID)2-s2.0-85018370850 (Scopus ID)
Available from: 2022-02-25 Created: 2022-02-25 Last updated: 2022-02-28Bibliographically approved
Enblom, A., Lindskog, E., Hasselbalch, H., Hersby, D., Bak, M., Tetu, J., . . . Andréasson, B. (2015). High rate of abnormal blood values and vascular complications before diagnosis of myeloproliferative neoplasms. European journal of internal medicine, 26(5), 344-347
Open this publication in new window or tab >>High rate of abnormal blood values and vascular complications before diagnosis of myeloproliferative neoplasms
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2015 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 26, no 5, p. 344-347Article in journal (Refereed) Published
Abstract [en]

Background: Vascular complications occurring before the diagnosis of myeloproliferative neoplasms (MPN) in 612 patients from four centers in Sweden, Denmark and France were retrospectively studied.

Results: Vascular complications were observed in 151 (25%) of the 612 patients. Of these, 66% occurred during the two years preceding diagnosis. The majority of events were thromboembolic (95%), and included myocardial infarction (n = 46), ischemic stroke (n = 43), transient ischemic attack (TIA) (n = 22), deep vein thrombosis/pulmonary embolism (n = 19), splanchnic vein thrombosis (n = 7), and peripheral embolism (n = 7). Bleeding was observed in only 7 (5%) of the 151 patients with vascular events (3 with intracranial bleeding, 2 with epistaxis and 2 with gastrointestinal bleeding). Full blood counts obtained at least 3 months prior to the MPN diagnosis showed that 269 (44%) had abnormal blood values, fulfilling the diagnostic criteria for MPN. During the time from the abnormal blood test to the diagnosis of MPN, 50 patients suffered from a vascular complication.

Conclusion: We therefore conclude that a large proportion of MPN patients suffer severe thromboembolic complications prior to diagnosis. If MPN were diagnosed earlier, a large proportion of these events might be prevented. An MPN should always be suspected and ruled out in patients with unexplained elevated hematocrit, leukocyte and/or platelet counts.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Myeloproliferative neoplasm, Polycythemia vera, Essential thrombocythemia, Myelofibrosis, Vascular complications
National Category
Hematology
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-192762 (URN)10.1016/j.ejim.2015.03.009 (DOI)000354577000008 ()25863408 (PubMedID)2-s2.0-84929506465 (Scopus ID)
Available from: 2022-02-25 Created: 2022-02-25 Last updated: 2022-02-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9984-3520

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