Abstract
Patients with polycythemia vera (PV) have a high incidence of thrombotic events (TEs), contributing to a greater mortality risk than the general population. The relationship between hematocrit (HCT) levels and TE occurrence among patients with PV from the Veterans Health Administration (VHA) was evaluated to replicate findings of the CYTO-PV trial with a real-world patient population. This retrospective study used VHA medical record and claims data from the first claim with a PV diagnosis (index) until death, disenrollment, or end of study, collected between October 1, 2005, and September 30, 2012. Patients were aged ≥ 18 years at index, had ≥ 2 claims for PV (ICD-9-CM code, 238.4) ≥ 30 days apart during the identification period, continuous health plan enrollment from 12 months pre-index until end of study, and ≥ 3 HCT measurements per year during follow-up. This analysis focused on patients with no pre-index TE, and with all HCT values either < 45% or ≥ 45% during the follow-up period. The difference in TE risk between HCT groups was assessed using unadjusted Cox regression models based on time to first TE. Patients (N = 213) were mean (SD) age 68.9 (11.5) years, 98.6% male, and 61.5% white. TE rates for patients with HCT values < 45% versus ≥ 45% were 40.3% and 54.2%, respectively. Among patients with ≥ 1 HCT before TE, TE risk hazard ratio was 1.61 (95% CI, 1.03–2.51; P = 0.036). This analysis of the VHA population further supports effective monitoring and control of HCT levels < 45% to reduce TE risk in patients with PV.
Highlights
Patients with polycythemia vera (PV) are at risk for arterial and venous thrombotic events (TEs)
TEs may contribute to the lower survival rate observed in patients with PV compared with the general population [6]
The National Comprehensive Care Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) emphasizes prevention of thrombosis occurrence and recurrence as a primary treatment goal for PV, along with controlling disease-related symptoms [7]. This recommendation is supported by the findings of the European Collaboration on Low-Dose Aspirin in Polycythemia Vera (ECLAP) study, which observed a significant reduction in the risk of TE and
Summary
Patients with polycythemia vera (PV) are at risk for arterial and venous thrombotic events (TEs). The National Comprehensive Care Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) emphasizes prevention of thrombosis occurrence and recurrence as a primary treatment goal for PV, along with controlling disease-related symptoms [7]. This recommendation is supported by the findings of the European Collaboration on Low-Dose Aspirin in Polycythemia Vera (ECLAP) study, which observed a significant reduction in the risk of TE and
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