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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Interventional Thrombolysis vs Anticoagulation Alone for Myeloproliferative Neoplasm-Associated Acute Venous Thromboembolism: A Real-World Propensity-Matched Analysis Hassaan J.Abbasi1, Devi Preetham R.Veeramagri1, Yashar Haghighi1, Patrick J.Willard2, Christopher W.Bailey3. 1Virginia Commonwealth University School of Medicine, Richmond, VA, USA.2Department of Hematology-Oncology, VCU Health, Richmond, VA, USA.3Division of Vascular Interventional Radiology, VCU Health, Richmond, VA, USA |
Abstract
Background: Patients with myeloproliferative neoplasms (MPNs) have an elevated risk of venous thromboembolism (VTE) despite anticoagulation. Although catheter-directed thrombolysis and thrombectomy (CDT) are established treatments for acute VTE, there is little evidence regarding their effectiveness for MPN patients. Long term outcomes of CDT with anticoagulation (AC) versus AC without CDT in this high-risk population are not established. Objectives: This study evaluates the 12-month recurrent VTE and all-cause mortality in a propensity-score matched, multicenter real-world cohort, comparing patients with MPN who develop acute VTE treated with CDT and anticoagulation versus anticoagulation alone. Methods: The TriNetX database was used to identify patients with polycythemia vera (PV), essential thrombocytopenia (ET), or myelofibrosis (MF) who experienced their first VTE after MPN diagnosis. VTE included pulmonary embolism, portal vein thrombosis, and upper and lower extremity deep vein thromboses. Patients who received CDT within 6 months on or after the VTE were compared to those treated without CDT after cohort balancing. Patients treated with CDT also received at least 1 year of post-procedure anticoagulation. Propensity-score matching was performed for age, sex, race/ethnicity, cardiovascular and metabolic comorbidities, liver disease, prior malignancies, history of thromboembolism or bleeding, and relevant medications. Primary outcomes included recurrent VTE and all-cause mortality and were evaluated up to 12 months after treatment. Odds ratio (OR) with 95% confidence intervals (CI) and Kaplan-Meier survival analyses with hazard ratios (HR) and log-rank testing were used to assess differences between groups, with statistical significance defined as p <0.05. Results: A total of 18,984 patients with MPNs experienced their first VTE were evaluated. Of these, 17,763 received CDT (with at least 1 year post procedure anticoagulation) and 1,221 received AC alone. After propensity-score matching, each cohort included 1,176 patients and was well balanced across demographics, comorbidities, and medications (Table 1). Patients treated with CDT+AC had a significantly higher risk of recurrent VTE compared with those treated only with AC alone (22.43% vs 6.93%; OR 3.881, 95% CI 2.203–6.835). Time-to-event analysis demonstrated a similar increase in cumulative incidence in the CDT cohort (HR 3.695, 95% CI 2.172-6.288; log-rank p≤0.0001). For all-cause mortality, the CDT cohort showed a higher mortality compared with the AC group (23.82% vs 22.31%). However, this difference was not statistically significant (OR 1.089, 95% CI 0.898–1.320). Survival analysis showed similar findings with no significant difference in overall survival between groups (HR 1.076, 95% CI 0.909–1.275; log-rank p = 0.3941). Conclusion: CDT+AC is associated with significantly higher 12-month rates of recurrent VTE compared with AC alone in patients with MPNs who developed acute VTE. However, there was no significant difference in all-cause mortality between groups. Therefore, although the role for CDT may benefit patients regarding symptom management and chronic venous insufficiency, CDT is likely not superior to anticoagulation alone in terms of thrombosis and mortality. Prospective studies are needed to understand the risks, mechanisms, and role of CDT in MPN-associated VTE.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.