Antithrombotic Management in Ischemic Stroke with Essential Thrombocythemia: Current Evidence and Dilemmas

Thrombotic diseases like ischemic stroke are common complications of essential thrombocythemia (ET) due to abnormal megakaryopoiesis and platelet dysfunction. Ischemic stroke in ET can occur as a result of both cerebral arterial and venous thrombosis. Management of ET is aimed at preventing vascular...

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Bibliographic Details
Published in:Medical principles and practice 2021-10, Vol.30 (5), p.412-421
Main Authors: Das, Shubhabrata, Deb, Anasua, Pal, Tanmoy
Format: Article
Language:English
Subjects:
Aspirin
Aspirin - administration & dosage
Aspirin - therapeutic use
Blood platelets
Blood tests
Cardiac arrhythmia
Epidemiology
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Genes
Humans
Ischemia
Ischemic Stroke
Kinases
Leukemia
Males
Medical imaging
Medical prognosis
Middle Aged
Mutation
Neuroimaging
Review
Risk factors
Stroke
Thrombocythemia, Essential - complications
Thrombocythemia, Essential - drug therapy
Thrombosis
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Summary:Thrombotic diseases like ischemic stroke are common complications of essential thrombocythemia (ET) due to abnormal megakaryopoiesis and platelet dysfunction. Ischemic stroke in ET can occur as a result of both cerebral arterial and venous thrombosis. Management of ET is aimed at preventing vascular complications including thrombosis. Acute management of ischemic stroke in ET is the same as that in the general population without myeloproliferative disorders. However, an ET patient with ischemic stroke is at high risk for rethrombosis and is therefore additionally managed with cytoreductive therapy and antithrombotic agents. Given abnormal platelet production in ET, there is suboptimal suppression of platelets with the standard recommended dose of aspirin for cardiovascular (CV) prevention. Hence, for optimal CV protection in ET, low-dose aspirin is recommended twice daily in an arterial thrombotic disease like atherothrombotic ischemic stroke in presence of the following risk factors: age >60 years, Janus kinase2 V617F gene mutation, and presence of CV risk factors. In the presence of the same risk factors, concurrent antiplatelet and anticoagulant therapy is suggested for venous thrombosis. However, increased risk of bleeding with dual antithrombotic agents poses a significant challenge in their use in cerebral venous thromboembolism or atrial fibrillation in presence of the above-mentioned risk factors. We discuss these dilemmas regarding antithrombotic management in ischemic stroke in ET in this case-based review of literature in the light of current evidence.
ISSN:1011-7571
1423-0151
DOI:10.1159/000516471