Alterations in visible light exposure modulate platelet function and regulate thrombus formation
Elizabeth A. Andraska 1),2); Frederik Denorme 3); Christof Kaltenmeier 2),4); Aishwarrya Arivudainabi 2); Emily P. Mihalko 1),5); Mitchell Dyer 6); Gowtham K. Annarapu 7); Mohammadreza Zarisfi 1); Patricia Loughran 1),2); Mehves Ozel 1); Kelly Williamson 1); Roberto Ivan Mota Alvidrez 8); Kimberly Thomas 9),10); Sruti Shiva 11); Susan M. Shea 1),5); Richard A. Steinman 2),12); Robert A. Campbell 3); Matthew R. Rosengart 13); Matthew D. Neal 1),2)
1) Department of Surgery, Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
2) University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
3) Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
4) MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC, USA
5) Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
6) Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
7) Pittsburgh Heart, Lung, Blood, Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
8) College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
9) Vitalant Research Institute, Denver, Colorado, USA
10) Department of Pathology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
11) Division of Classical Hematology, Department of Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
12) Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
13) Division of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
Abstract
Introduction
There are few large-scale, population-based studies detailing the risks of thrombosis, hemorrhage, leukemic transformation in patients with myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF).
Methods
We performed a nationwide longitudinal cohort study using the Korean National Health Insurance System (NHIS) database. MPN patients (n = 11,991) and their 1:4 age- and sex-matched controls (n = 47,964) were enrolled. The risk of thrombosis, hemorrhage, leukemic transformation was estimated using a Cox proportional hazards regression, and stratified analyses were performed for related factors.
Results
During a median of 7.8 years of follow-up, 30.1 % of MPN patients (3614/11,991) and 19.0 % of the matched controls (9141/47,964) developed arterial thrombosis, 11.6 % of MPN patients (1397/11,991) and 6.4 % of the matched controls (3099/47,964) developed venous thrombosis and 18.7 % of MPN patients (2251/11,991) and 12.1 % of the matched controls (5836/47,964) developed hemorrhage. 4.9 % of MPN patients (597/11,991) and 0.1 % of matched controls (50/47,964) developed leukemia. The overall risk of developing thrombosis, hemorrhage, leukemic transformation was higher in MPN patients (adjusted hazard ratio [aHR] 1.695, 95 % confidence interval [CI]: 1.629–1.765 for arterial thrombosis, aHR 1.963, 95 % CI: 1.838–2.096 for venous thrombosis, and aHR 1.714, 95 % CI: 1.630–1.802 for hemorrhage) than in the controls. Patients with MPNs had a 10-year cumulative incidence of leukemic transformation of 6.2 %.
Conclusion
The patients with MPNs have a higher risk of thrombosis, hemorrhage, and leukemic transformation than matched controls. Strategies are warranted to reduce the risk of thrombosis, hemorrhage, and leukemic transformation in MPN patients.