Arterial and Venous Thrombosis in Patients with Myeloproliferative Neoplasms

Abstract

Introduction Patients with myeloproliferative neoplasms (MPNs) face a high risk of arterial and venous thrombosis, a primary driver of morbidity and mortality. This literature review synthesizes recent evidence on the pathogenesis, prevalence, and clinical implications of thrombosis in this population.

Methods This comprehensive literature review analyzes seven key articles published between 2021 and 2024. The analysis covers the association of thrombosis with genetic drivers, the concept of thromboinflammation, comorbidities like kidney dysfunction, and its occurrence in both common and unusual vascular sites.

Results The literature reveals a high prevalence of thrombosis, with rates of arterial events reaching 16.2% in a meta-analysis and a history of thrombosis reported in up to 29% of patients in one cohort. The pathogenesis is linked to driver mutations (JAK2, CALR, MPL) that promote a chronic "thromboinflammatory" state. Comorbidities such as kidney dysfunction further increase this risk. Notably, thrombosis occurs in unusual sites, like splanchnic veins, in nearly 40% of individuals , and these events are a key determinant of survival.

Discussion The findings establish thrombosis as a central pathological feature of MPNs, driven by thromboinflammation. This necessitates a management strategy that targets both the clonal disorder and the resulting inflammatory state. The diversity of risk factors and clinical presentations requires individualized risk stratification over uniform treatment protocols.

Conclusion A multidisciplinary and individualized approach is critical for managing thrombotic risk in MPN patients. Effective management requires integrating genetic profiling, controlling comorbidities, and maintaining vigilance for thrombotic events in all vascular sites to improve patient outcomes.