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Risk assessment and perioperative management are important aspects of improving QOL and preventing complications in surgeries for patients with MPNs.

Risk factors for bleeding and thrombosis among patients with myeloproliferative neoplasms (MPNs) who are scheduled for surgery are multifaceted and require consideration of individual patient characteristics, risk assessment, and perioperative management, according to results published in Cureus.

“Thrombosis, venous or arterial, is a major cause of mortality and morbidity in [essential thrombocythemia (ET)] and [polycythemia vera], while bleeding is more concerning in [myelofibrosis] and ET,” Mihaela Andreescu, MD, PhD, and colleagues wrote. “Surgical procedures also pose a significant risk for bleeding in MPNs, with a probability of 7.2% during surgery. Assessing bleeding and thrombosis risk in patients scheduled for surgery is crucial to optimize patient outcomes.”

Specific Risks for Bleeding and Thrombosis

Risk assessment tools included rational elastrometry (ROTEM), International Predictive Score for Thrombosis in ET (IPSET), and the dynamic international prognostic scoring system (DIPSS).

The researchers identified age (>60), history of thrombosis, and genetic mutations, particularly variants of JAK2V617F, as risk factors for thrombosis in patients with MPN. Risk factors for bleeding included leukocytosis, thrombocytosis, acquired von Willebrand syndrome, and history of bleeding.

“Individual patient factors must be considered to minimize severe bleeding and thrombotic complications in surgeries,” Dr. Andreescu and colleagues wrote. “Risk assessment and perioperative management are important aspects of improving the QOL and preventing complications in surgeries.”

Assessing Risk and Individualizing Management

Managing thrombosis in patients with MPNs should be based on risk, the researchers noted, and can include aspirin and anticoagulants. To manage bleeding, the authors discussed the importance of avoiding aspirin and certain other pharmacotherapies, while noting that transfusions may be needed.

“Due to a high risk for bleeding and thrombosis in [patients with MPN], reassessment of antiplatelet, cytoreductive, and anticoagulant treatments is required,” Dr. Andreescu and colleagues wrote. “Individual patient factors must be considered to minimize severe bleeding and thrombotic complications in surgeries. Risk assessment and perioperative management are important aspects of improving the quality of life and preventing complications in surgeries. Further analysis and studies are required for the confirmation of risk assessment factors for both thrombosis and bleeding events in [patients with MPN].”