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Platelet-Associated Hypercoagulability in Patients with Essential Thrombocythemia and Polycythemia Vera

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Platelet-Associated Hypercoagulability in Patients with Essential Thrombocythemia and Polycythemia Vera Platelet-associated hypercoagulability in patients with Essential Thrombocythemia and Polycythemia Vera Citation for published version (APA): Panova-Noeva, M. (2012). Platelet-associated hypercoagulability in patients with Essential Thrombocythemia and Polycythemia Vera. Maastricht University. https://doi.org/10.26481/dis.20121129mp Document status and date: Published: 01/01/2012 DOI: 10.26481/dis.20121129mp Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.umlib.nl/taverne-license Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 02 Oct. 2021 PLATELET-ASSOCIATED HYPERCOAGULABILITY IN PATIENTS WITH ESSENTIAL THROMBOCYTHEMIA AND POLYCYTHEMIA VERA © Marina Panova-Noeva, Maastricht 2012 Thesis Maastricht University ISBN: 978-9989-57-865-6 Layout by: Marina Panova-Noeva and Igor Noev Cover design by: Igor Noev Printed by: Printing facility of the Ospedali Riuniti of Bergamo, Italy All rights reserved. No part of the thesis may be reproduced, stored in a retriev- al system or transmitted in any form or by any means, without the permission in writing from the author, or, when appropriate, of the publishers of the publi- cation. Platelet-associated hypercoagulability In patients with Essential Thrombocythemia And Polycythemia Vera PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit Maastricht op gezag van de Rector Magnificus, Prof. dr. L.L.G.Soete, volgens het besluit van het College van Decanen, in het openbaar te verdedigen op Donderdag 29 November 2012 om 10.00 uur door Marina Panova-Noeva Promotor Prof. dr. H. ten Cate Copromotors Dr. A. Falanga Dr. M. Marchetti Beoordelingscommissie Prof. dr. J. Rosing (Chairman) Prof. dr. H.C.J. Eikenboom (Leids Universitair Centrum) Prof. dr. S. Middeldorp (AMC Amsterdam) Prof. dr. H.C. Schouten Dr. W. van Werkum (St. Antonius Ziekenhuis Nieuwegein) The research described in this thesis was partially supported by a grant of the Annadal Foundation of Maastricht (The Netherlands) and of the Italian Associa- tion for Cancer Research (AIRC, Milan, Italy). To my father Contents Chapter 1: General Introduction ................................................................................................ 9 PART ONE Pathogenesis and treatment of thrombosis in cancer Chapter 2: Procoagulant mechanisms in tumour cells .................................................. 23 Chapter 3: Treatment of thromboembolism in cancer patients ................................ 43 PART TWO Chapter 4: Monitoring thrombin generation: is addition of corn trypsin inhibitor needed? .................................................................................................. 65 PART THREE Hypercoagulability in essential thrombocythemia and poly- cythemia vera Chapter 5: Platelet-induced thrombin generation by the calibrated auto- mated thrombogram assay is increased in patients with es- sential thrombocythemia and polycythemia vera................................... 81 Chapter 6: JAK2V617F mutation and hydroxyurea treatment as determi- nants of immature platelet parameters in essential thrombo- cythemia and polycythemia vera patients ............................................... 101 Chapter 7: Evaluation of Aspirin use on Platelet Function by Platelet Function Analyser and Thrombin Generation Assay in pa- tients with Essential Thrombocythemia and Polycythemia Vera ........................................................................................................................... 109 Chapter 8: ADP-induced whole blood aggregation and platelet-associated thrombin generation (TG) are increased in Essential Throm- bocythemia (ET) and Polycythemia Vera (PV) patients .................... 125 Chapter 9: Nitric oxide derivatives and soluble plasma selectins in pa- tients with myeloproliferative neoplasms ............................................... 143 Chapter 10: Summary, general discussion and conclusions. .................................. 159 Curriculum Vitae.......................................................................................................................... 171 Publications ................................................................................................................................... 173 Acknowledgements .................................................................................................................... 179 CHAPTER 1 General Introduction 9 10 General Introduction Thrombosis and cancer Thrombosis and cancer are among the most frequent diseases in the developed world of today. According to the latest publication by the World Health Organi- zation (WHO) on global burden of disease, ischemic heart diseases followed by cancer are the leading causes of death in developed countries.[1] The associa- tion between thrombosis and cancer is complex, and the interacting mechan- isms include non-specific factors related to the host response to tumor (i.e. in- flammation, paraproteinemia and venous stasis), anti-cancer treatment and cancer-cell prothrombotic activities. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality in cancer patients.[2-3] Patients with active cancer have a 6 - 7 times increased risk of developing symptomatic VTE compared to noncancer patients.[4-5] In addition, VTE can be the first symptom of an occult cancer. In the large popula- tion-based studies, from 10% to 20% of all patients presenting with an idi- opathic or unprovoked VTE were diagnosed with underlying cancer within the next 1-2 years.[6-7] The risk of developing VTE varies according to the type of malignancy, being highest in patients with malignant brain tumors, hematological malignancies, and tumors of the pancreas, uterus, ovary, stomach, lung, and kidney.[4, 8-10] Conventional cytotoxic chemotherapy is an independent risk factor for throm- bosis with an incidence rate between 10-20% per year. [5, 11] Recently, a pre- dictive model for a symptomatic VTE during the first four cycles of chemothe- rapy has been established, grouping the patients into three categories based on their total risk score. [12] Primary anticoagulant prophylaxis is recommended in all cancer patients hos- pitalized for medical or surgical reasons.[13] The initial treatment of acute VTE in cancer patients is identical as in non-cancer patients. Differently, for the long term therapy of VTE in cancer, low-molecular-weight heparin (LMWH) is pre- ferred as monotherapy for at least 3 months followed by LMWH or warfarin as long as the cancer is active.[14] Thrombosis in Essential Thrombocythemia and Polycythemia Vera Essential thrombocythemia (ET) and Polycythemia Vera (PV) are two Myelo- proliferative Neoplasms (MPNs) characterized by an excessive hematopoietic progenitor cell proliferation leading to an overproduction of one or more circu- lating blood cells.[15] ET patients typically present with high platelet count and PV patients with high red cell count. Diagnosis of ET and PV is currently accord- 11 CHAPTER I ing to WHO criteria, based on clinical and laboratory criteria (Figure 1). PV di- agnosis requires meeting either both major criteria and one minor criterion or the first major criterion and two minor criteria. ET diagnosis requires meeting all four major criteria.[16] The clinical course of ET and PV is frequently com- plicated by thrombotic events, progression to myelofibrosis, and hemorrhages responsible for 41%, 13% and 4% of patients’ mortality, respectively.[17] Figure 1. 2008 WHO diagnostic criteria for ET and PV. Major criteria Minor criteria 9 1. Sustained platelet count > 450 x 10 /L. 2. Megakaryocyte proliferation with large and mature morphology. 3. Not meeting WHO criteria for CML, PV, PMF, MDS, or other myeloid neoplasm T diagnosis 4. Demonstration of JAK2V617F or other E clonal marker or no evidence of reac- tive thrombocytosis. 1. Hgb > 18.5 g/dL (men) > 16.5 g/dL 1. Bone marrow
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