Prevention of cerebrovascular disease in patients with myeloproliferatie disorders

Abstract

Introduction. Hemorheological abnormalities in patients with Ph-negative myeloproliferative disorders (MPD) may lead to the development and/or progression ofcerebrovascular pathology. Adequate preventive therapy in such cases lowers the risk of cerebral thrombotic complications.

Objective. Evaluation of the effect of dipiridamole and acetylsalicylic acid (ASA) on platelet and erythrocyte aggregation, as well as morphofunctional properties of erythrocytes in patients with cerebrovascular disease (CVD) on the background of MPD.

Materials and methods. The study comprised 40 patients with various forms of CVD and Рh-negative MPD: 20 patients received dipyridamole, 20 – ASA for prevention of cerebral thrombotic complications. Mean study age was 44.6 years [35; 58.5]. A thorough clinical and neurological examination was performed, as well as neuroimaging studies, coagulation tests, analysis of platelet aggregation and rheological properties of erythrocytes.

Results. Within the observation period (median – 6.3 months) no acute cerebrovascular events in both groups were observed. Platelet aggregation (induced by ADP or adrenaline) was similar in both groups. Dipyridamole and ASA were also similar in their effect on functional properties of erythrocytes.

Conclusion. Our findings suggest that the therapeutic effect of dipyridamole concerning CVD is similar to that of ASA. Dipyridamole can be recommended for use in patients with Рh-negative MPD if other antiplatelet agents are contraindicated.

About the authors

Marine M. Tanashyan

Research Center of Neurology

Email: rasckey@live.com
Russian Federation, Moscow

Polina I. Kuznetsova

Research Center of Neurology

Email: rasckey@live.com
Russian Federation, Moscow

Alla A. Shabalina

Research Center of Neurology

Email: rasckey@live.com
ORCID iD: 0000-0001-9604-7775

D. Sci. (Med.), leading researcher, Head, Laboratory of hemorheology, hemostasis and pharmacokinetics (with clinical laboratory diagnostics)

Russian Federation, Moscow

Anton A. Raskurazhev

Research Center of Neurology

Author for correspondence.
Email: rasckey@live.com
ORCID iD: 0000-0003-0522-767X

Cand. Sci. (Med.), neurologist, researcher, 1st Neurology department

Russian Federation, Moscow

References

  1. Duangnapasatit B., Rattarittamrong E., Rattanathammethee T. et al. Clinical Manifestations and Risk Factors for Complications of Philadelphia Chromosome-Negative Myeloproliferative Neoplasms. Asian Pac Journal Cancer Prev. 2015; 16(12): 5013-8. doi: 10.7314/APJCP.2015.16.12.5013. PMID: 26163633
  2. Tefferi A., Thiele J., Vardiman J.W. The 2008 World Health Organization Classification System for Myeloproliferative Neoplasms. Cancer. 2009; 115(9): 3842–3847 doi: 10.1002/cncr.24440. PMID: 19472396
  3. Tefferi A. Pathogenesis of myelofibrosis with myeloid metaplasia. Journal of Clinical Oncology. 2005; 23(33): 8520-30. doi: 10.1200/JCO.2004.00.9316. PMID: 16293880
  4. Alvarez-Larran A., Cervantes F., Bellosillo B. et al. Essential Thrombocythemia in Young Individuals: Frequency and Risk Factors for Vascular Events and Evolution to Myelofibrosis in 126 Patients. ASH Annual Meeting Abstracts. 2006; 108(11): 3598. doi: 10.1038/sj.leu.2404693. PMID: 17519959
  5. Kaifie A., Kirschner M., Wolf D., et al. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. Journal Hematol Oncology. 2016; 9: 18. doi: 10.1186/s13045-016-0242-9.
  6. Arellano-Rodrigo E., Alvarez-Larrán A., Reverter J.C. et al. Increased platelet and leukocyte activation as contributing mechanisms for thrombosis in essential thrombocythemia and correlation with the JAK2 mutational status. Haematologica. 2006; 91(2): 169-175. PMID: 16461300
  7. Falanga A., Marchetti M., Vignoli A. et al. V617F JAK-2 mutation in patients with essential thrombocythemia: relation to platelet, granulocyte, and plasma hemostatic and inflammatory molecules. Exp Hematol. 2007; 35(5): 702-711. PMID: 17577920
  8. Falanga A., Marchetti M., Barbui T., Smith C.W. Pathogenesis of thrombosis in essential thrombocythemia and polycythemia vera: the role of neutrophils. Semin Hematol. 2005; 42(4): 239-247. doi: 10.1053/j.seminhematol.2005.05.023
  9. Marchetti M., Falanga A.. Leukocytosis, JAK2V617F mutation, and hemostasis in myeloproliferative disorders. Pathophysiol Haemost Thromb. 2008; 36(3-4): 148-159. doi: 10.1159/000175153. PMID: 19176988
  10. Falanga A., Marchetti M., Vignoli A. et al. Leukocyte-platelet interaction in patients with essential thrombocythemia and polycythemia vera. Exp Hematol. 2005;33(5):523-530. doi: 10.1016/j.exphem.2005.01.015. PMID: 15850829
  11. De Stefano V., Za T., Rossi E. et al. Influence of the JAK2 V617F mutation and inherited thrombophilia on the thrombotic risk among patients with essential thrombocythemia. Haematologica. 2009; 94(5): 733-737. doi: 10.3324/haematol.13869. PMID: 19336736.
  12. Campbell P.J., MacLean C., Beer P.A. et al. Correlation of blood counts with vascular complications in essential thrombocythemia: analysis of the prospective PT1 cohort. Blood. 2012; 120(7): 1409-1411. doi: 10.1182/blood-2012-04-424911.
  13. Derry S., Loke Y.K. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ. 2000; 321(7270): 1183–7. DOI: https://doi.org/10.1136/bmj.321.7270.1183
  14. Tanashyan M., Kuznetsova Р., Shabalina A. et al. Clinical Characteristics of Cerebrovascular Pathology with Patients Suffering from Ph-Negative Myeloproliferative Disease. Cerebrovascular diseases extra. 2016; 6(3): 66-70. doi: 10.1159/000448597. PMID: 27598581.
  15. Kim H.H., Liao J.K. Translational therapeutics of dipyridamole. Arterioscler Thromb Vasc Biol. 2008; 28: 39–42. doi: 10.1161/ATVBAHA.107.160226. PMID: 18174451.
  16. Leonardi-Bee J., Bath P.M., Bousser M.G. et al. Dipyridamole for preventing recurrent ischemic stroke and other vascular events: a meta-analysis of individual patient data from randomized controlled trials. Stroke. 2005; 36(1): 162–8. doi: 10.1161/01.STR.0000149621.95215.ea.
  17. M.M. Tanashyan, M.A. Domashenko. [Dipiridamol in the complex therapy og chronic cerebrovascualr disease]. Nervnye bolezni. 2012; 3: 27-30 (in Russ.)
  18. Michiels J.J., Koudstaal P.J., Mulder A.H. Transient neurologic and ocular manifestations in primary thrombocythemia. Neurology. 1993; 43: 1107-10. PMID: 8170552.
  19. Lengfelder E., Hochhaus A., Kronawitter U. Should a platelet limit of 600х109/l be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages. Br Journal Haematology. 1998; 100: 15-23. PMID: 9450785
  20. Michiels J.J., Berneman Z., Schroyens W. Plateled-mediated erythromelalgic, cerebral, ocular and coronary microvascular ischemic and thrombotic manifestations in patients with essential thrombocythemia and polycythemia vera: a distinct aspirin-responsive and coumadin-resistant arterial thrombophilia. Platelets. 2006; 17: 528-44. doi: 10.1080/09537100600758677. PMID: 17127481.
  21. Harrison C. Pregnancy and its management in the Philadelphia negative myeloproliferative diseases. Br Journal Haematology. 2005; 129: 293-306. doi: 10.1111/j.1365-2141.2005.05400.x. PMID: 15842653
  22. Tanashyan M.M., Kuznetsova P.I., Lagoda O.V. et al. [Myeloproliferative diseases and ischemic stroke]. Annals of Clinical and Experimental Neurology. 2014; 8(2): 41-45 (in Russ.)
  23. M.M. Tanashyan, M.A. Domashenko. [Kurantil in patients with chronic cerebrovascular disease]. Nervnye bolezni. 2005; 3: 8-11 (in Russ.).

Copyright (c) 2017 Tanashyan M.M., Kuznetsova P.I., Shabalina A.A., Raskurazhev A.A.

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