Is the recommended hematocrit target in polycythemia vera evidence based? Tiziano BARBUI, MD Ospedali Riuniti, Bergamo, Italy

Size: px
Start display at page:

Download "Is the recommended hematocrit target in polycythemia vera evidence based? Tiziano BARBUI, MD Ospedali Riuniti, Bergamo, Italy"

Transcription

1 Is the recommended hematocrit target in polycythemia vera evidence based? Tiziano BARBUI, MD Ospedali Riuniti, Bergamo, Italy

2 We have generated a transgenic mouse line that reaches a hematocrit concentration of 0.85 due to constitutive overexpression of human erythropoietin in an oxygen independent manner. Unexpectedly, this excessive erythrocytosis did not lead to thrombembolic complications in all investigated organs at any age.

3 Elevated hematocrit, risk of thrombosis, and polycythemia vera ( Prchal, Blood 2003,letter) In conditions associated with elevated hematocrit such as polycythemia of high altitude, erythropoietin receptor mutations, Chuvash polycythemia, hemoglobin mutants with high oxygen affinity, and 2,3 BPG deficiency, the rates of thrombotic complications are far below those seen in patients with PV. These observations suggest that the thrombotic complications of PV may be induced, at least in part, by other unique features of PV, such as quantitative and qualitative defects of platelets and neutrophils; these myeloid cells are, after all, the progeny of the same mutated hematopoietic stem cell as the red cells.

4 Thrombosis during follow up in 1638 PV patients (Eclap)* Fatal and nonfatal cardiovascular events n=226 Myocardial infarction 0.9 Stroke/TIA Peripheral arterial thrombosis Deep vein thrombosis and PE Marchioli et al, JCO 2005

5

6 . Risk of stroke in adults with cyanotic congenital heart disease. Perloff JK, Marelli AJ, Miner PD. Circulation Jun;87(6): cyanotic patients years old (mean, 36 +/ 11.7 years) in the UCLA Adult Congenital Heart Disease Center Registry were selected for study by virtue of continuous observation for 1 12 years (total, 748 patient years). No patient with either compensated or decompensated erythrocytosis, irrespective of hematocrit level, iron stores, or the presence, degree, or recurrence of cerebral hyperviscosity symptoms, progressed to clinical evidence of a complete stroke (cerebral arterial thrombosis with brain infarction).

7 Results from the Tromsø study* in the general population (survey in Tromsø, Norway) show that a hematocrit in the upper 20th percentile was found to be associated with a 1.5 fold increased risk of venous thrombosis. The link found between high hematocrit and risk of venous thrombosis is real, but there is uncertainty on whether the relation is causal or explained by other diseases. No clear data from multivariate analysis. Do high levels of hematocrit interact with other risk factors for venous thrombosis and, therefore, increase the risk of venous thrombosis even more? Could it indeed explain part of the link between arterial and venous thrombosis, as the authors suggest? * Brækkan et al, Haematologica 2012

8 Evidence for recommendation to maintain Ht<45% PVSG 01 Treatment by phlebotomy alone resulted in a higher incidence of thrombosis during the first 3 years 60 Percentage P Phlebotomy Chlorambucil Death Thrombosis AML Malignancy 1

9 Hematocrit was not a risk factor for thrombosis in the PVSG 01 trial In multivariate analysis, pre-treatment hematocrit was not associated with thrombosis. In a case-control analysis, Ht measured at the closest observation prior to thrombotic event (up to 52%) - and compared with that in the matched control at the corresponding time on study - was not associated with thrombosis

10 ECLAP Central Coordination Central registry RCT Clear Indication to ASA 518 ASA Uncertain benefit/risk ratio Clear Contraindication for ASA Cohort for the Evaluation of Natural History (1,638 pts)

11 Packed Cell Volume (L/L) 0,60 0,55 0,50 0,45 0,40 0,35 0,30 Hematocrit 0,550 0,506 0,500 0,500 0,498 0,484 0,468 0,453 0,453 0,453 0,455 0,455 0,400 0,407 0,396 0,388 0,382 0, No. of patients ,431 1,240 1, Months

12 Time dependent multivariate analysis on the relative risk of major thrombosis among men and women with Polycythemia Vera (N = 1,638)* *Model adjusted for: age, gender, time from PV diagnosis to recruitment, thrombotic or hemorrhagic events prior to recruitment, smoking, history of diabetes, hypertension, claudicatio intermittens, erythromelalgia, splenomegaly, circulating immature cells, leukocyte count, total blood cholesterol, phlebotomy use, interferon use, hydroxyurea use, antiplatelets use, anticoagulants use, 32 P use, busulfan use, chlorambucil use, and pipobroman use Di Nisio, Barbui, et al., Brit J.Haematol.2007

13 Time-dependent multivariate analysis on the relative risk of major thrombosis among men and women with Polycythemia Vera (N = 1,638)* Hazard ratio (95% CI), P-value Hematocrit (%) 45 (N=556) 1 (Reference) (N=530) 0.89 ( ), 0.6 > 50 (N=345) 1.04 ( ), 0.9 Platelet number (x10 9 /l) 300 (N=592) 1 (Reference) (N=622) 0.78 ( ), 0.2 > 500 (N=407) 0.67 ( ), 0.1 *Model adjusted for: age, gender, time from PV diagnosis to recruitment, thrombotic or hemorrhagic events prior to recruitment, smoking, history of diabetes, hypertension, claudicatio intermittens, erythromelalgia, splenomegaly, circulating immature cells, leukocyte count, total blood cholesterol, phlebotomy use, interferon use, hydroxyurea use, antiplatelets use, anticoagulants use, 32 P use, busulfan use, chlorambucil use, and pipobroman use Di Nisio, Barbui et al, 2007

14

15 EFFECT OF ASPIRIN ON THE RISK OF MAJOR ARTERIAL OR VENOUS EVENT, OR DEATH FROM CARDIOVASCULAR CAUSES IN VARIOUS SUBGROUPS N Engl J Med, 2004;350:

16 Polycythemia vera: myths, mechanisms, and management Jerry L. Spivak (Blood 2002 ) «unless the red cell mass is appropriately reduced, antiplatelet therapy or chemotherapy will be futile «

17 A large scale trial testing the intensity of CYTOreductive therapy to prevent cardiovascular events In patients with Polycythemia Vera (PV) CYTO PV (Clinical Trials Gov NCT Study Chair: Tiziano BARBUI Sponsor: Consorzio Mario Negri Sud Study funded by Agenzia Italiana del Farmaco (AIFA), Project #FARM6YNXAN

18 Eligible patients Confirmed diagnosis of PV All inclusion criteria No exclusion criteria Entry visit* Written informed consent Standard cytoreduction (HCT 40-45%) Experimental cytoreduction (HCT 45-50%) A patient can be randomized in the trial, provided she/he meets all recruitment criteria. Clinical visits at 3*, 6*, 12*, 18, 24*, 30, 36*, 42, 48*, 54, 6 0* months. * the following laboratory tests must be performed: hematocrit, hemoglobin, red and white cell count, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, uricoemia, glucose levels, total CK, ALT, AST, creatinine, potassium, sodium, fibrinogen, spleen and liver ultrasonography (specific tests for PV to added). Figure 1 Study design

19 Hematocrit (%) during the study Pct <45% Median <45% 25 Pct <45% 75 Pct 45 50% Median 45 50% 25 Pct 45 50% 47,4 48,3 48,3 47,0 47,2 47,5 47,7 47,2 46,9 44,7 45,0 44,2 44,4 44,4 44,3 44, No of patients Months

The treatment of polycythaemia vera: an update in the JAK2 era

The treatment of polycythaemia vera: an update in the JAK2 era Intern Emerg Med (2007) 2:13 18 DOI 10.1007/s11739-007-0003-4 IM REVIEW G. Finazzi T. Barbui The treatment of polycythaemia vera: an update in the JAK2 era Received: 31 August 2006 / Accepted in original

More information

European Focus on Myeloproliferative Diseases and Myelodysplastic Syndromes A critical reappraisal of anagrelide in the management of ET

European Focus on Myeloproliferative Diseases and Myelodysplastic Syndromes A critical reappraisal of anagrelide in the management of ET European Focus on Myeloproliferative Diseases and Myelodysplastic Syndromes 2012 Clinical i l Aspects of Polycythemia and Essential Thrombocythemia A critical reappraisal of anagrelide in the management

More information

Highest rates of thrombosis = age > 70, history of thrombosis, active disease (> 6 phlebotomies/yr) [2]

Highest rates of thrombosis = age > 70, history of thrombosis, active disease (> 6 phlebotomies/yr) [2] Polycythemia Vera Treatment Policy Prepared by Dr. Jeannie Callum Updated May 2003 Introduction PV is a chronic, clonal, myeloproliferative disorder, classically associated with an increase in red cell

More information

Why do patients with polycythemia vera clot? Kinsey McCormick Hematology Fellows conference August 10, 2012

Why do patients with polycythemia vera clot? Kinsey McCormick Hematology Fellows conference August 10, 2012 Why do patients with polycythemia vera clot? Kinsey McCormick Hematology Fellows conference August 10, 2012 Outline Case presentation Overview of PV Disease course Mechanisms of thrombosis Case Presentation

More information

CLINICAL CASE PRESENTATION

CLINICAL CASE PRESENTATION European Winter School of Internal Medicine 2015 Riga, Latvia, 26-30 January CLINICAL CASE PRESENTATION Vasiliy Chulkov South Ural State Medical University (Chelyabinsk, Russia) CHELYABINSK CLINICAL HISTORY

More information

Emerging diagnostic and risk stratification criteria

Emerging diagnostic and risk stratification criteria PV STATE OF MIND Polycythemia vera: Emerging diagnostic and risk stratification criteria Rami S. Komrokji, MD Moffitt Cancer Center, Tampa, Florida Disclosure These slides were developed by Incyte Corporation

More information

Practice Patterns in the Diagnosis and Treatment of Polycythemia Vera in the Post JAK2 V617F Discovery Era

Practice Patterns in the Diagnosis and Treatment of Polycythemia Vera in the Post JAK2 V617F Discovery Era 1238 Original Research Practice Patterns in the Diagnosis and Treatment of Polycythemia Vera in the Post JAK2 V617F Discovery Era Elizabeth M. Kander, MD a ; Alison R. Moliterno, MD b ; Alfred Rademaker,

More information

Managing ET in Tiziano Barbui MD

Managing ET in Tiziano Barbui MD Managing ET in 2019 Tiziano Barbui MD (tbarbui@asst-pg23.it) Hematology and Foundation for Clinical Research, Hospital Papa Giovanni XXIII Bergamo, Italy Managing ET in 2019 Establish diagnosis Risk Stratification

More information

Hydroxyurea: the comparator in studies with new anti-jak2 inhibitors

Hydroxyurea: the comparator in studies with new anti-jak2 inhibitors Hematology Meeting Reports 2009;3(3):108 114 SESSION VIII xg. Finazzi T. Barbui 1 x Divisione di Ematologia e 1 Fondazione per la Ricerca Ospedali Riuniti di Bergamo, Italy Hydroxyurea: the comparator

More information

Medical Management of Adult Congenital Heart Disease

Medical Management of Adult Congenital Heart Disease Medical Management of Adult Congenital Heart Disease 1. Erythrocytosis 2. Pulmonary Hemorrhage 3. The Thrombosis Dilemma 4. Non-Cardiac Surgery: a) The anesthesiologist b) Bilirubin kinetics c) Post operative

More information

Myeloproliferative Disorders in the Elderly: Clinical Presentation and Role of Bone Marrow Examination

Myeloproliferative Disorders in the Elderly: Clinical Presentation and Role of Bone Marrow Examination Myeloproliferative Disorders in the Elderly: Clinical Presentation and Role of Bone Marrow Examination Arati V. Rao, M.D. Division of Medical Oncology and Geriatrics Duke University Medical Center Durham

More information

EUROPEAN RCT IN MPDs

EUROPEAN RCT IN MPDs EUROPEAN RCT IN MPDs A. Multicenter, Multinational -EORTC -ECLAP -ANHIDRET B. Multicenter, National -French PV RCTs -Italian ET RCT - PT- RCTs C. European Leukemia NET studies D. Future: JAK-2 inhibitor

More information

Myelodysplastic syndrome (MDS) & Myeloproliferative neoplasms

Myelodysplastic syndrome (MDS) & Myeloproliferative neoplasms Myelodysplastic syndrome (MDS) & Myeloproliferative neoplasms Myelodysplastic syndrome (MDS) A multipotent stem cell that can differentiate into any of the myeloid lineage cells (RBCs, granulocytes, megakaryocytes)

More information

CME Information: Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification, and management

CME Information: Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification, and management AJH CME Information: Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification, and management Author: Ayalew Tefferi If you wish to receive credit for this activity,

More information

Latest updates in Myeloproliferative Neoplasms. Elizabeth Hexner, MD, MSTR

Latest updates in Myeloproliferative Neoplasms. Elizabeth Hexner, MD, MSTR Latest updates in Myeloproliferative Neoplasms Elizabeth Hexner, MD, MSTR Disclosures Nothing to disclose Agenda/Goals Treatment goals in PV Indications for cytoreduction in patients polycythemia vera

More information

Polycythemia vera (PV), a myeloproliferative disorder

Polycythemia vera (PV), a myeloproliferative disorder Myeloproliferative Disorders research paper Polycythemia vera in young patients: a study on the long-term risk of thrombosis, myelofibrosis and leukemia FRANCESCO PASSAMONTI, LUCIA MALABARBA, ESTER ORLANDI,

More information

How to monitor MPN patients

How to monitor MPN patients How to monitor MPN patients MPN carries significant burden and risk Transformation to MF or AML 1 Neurological complications 2 MPN-associated general symptoms (eg, pruritus, fatigue) 3 Microvascular symptoms

More information

Chronic Myeloproliferative Disorders

Chronic Myeloproliferative Disorders 1 Chronic Myeloproliferative Disorders 15th 9 April2015 Polycythemia vera Essential thrombocythemia Idiopathic primary myelofibrosis 2 Learning objectives To appreciate types of polycythaemia (erythrocytosis)

More information

Focus on aggressive polycythemia vera

Focus on aggressive polycythemia vera Focus on aggressive polycythemia vera Jerry L. Spivak, MD Professor of Medicine and Oncology Director, the Johns Hopkins Center for the Chronic Myeloproliferative Disorders Johns Hopkins University School

More information

Rischio emorragico e trombotico nella TE e PV

Rischio emorragico e trombotico nella TE e PV Convegno Interregionale SIE Delegazione Triveneto Approfondimento sulle sindromi mielodisplastiche e mieloproliferative Sessione: Sindromi Mieloproliferative Croniche Rischio emorragico e trombotico nella

More information

RESPONSE (NCT )

RESPONSE (NCT ) Changes in Quality of Life and Disease-Related Symptoms in Patients With Polycythemia Vera Receiving Ruxolitinib or Best Available Therapy: RESPONSE Trial Results Abstract #709 Mesa R, Verstovsek S, Kiladjian

More information

The Internists Approach to Polycythemia and Implications of Uncontrolled Disease

The Internists Approach to Polycythemia and Implications of Uncontrolled Disease The Internists Approach to Polycythemia and Implications of Uncontrolled Disease Mary Jo K. Voelpel, DO, FACOI, MA, CS Associate Clinical Professor MSU-COM Disclosures NONE Overview 1. Objectives 2. Case

More information

Leukemia and subsequent solid tumors among patients with myeloproliferative neoplasms

Leukemia and subsequent solid tumors among patients with myeloproliferative neoplasms Leukemia and subsequent solid tumors among patients with myeloproliferative neoplasms Tiziano Barbui (tbarbui@asst-pg23.it Hematology and Research Foundation,Ospedale Papa Giovanni XXIII, Bergamo Italy

More information

ESSENTIAL thrombocythemia is a myeloproliferative

ESSENTIAL thrombocythemia is a myeloproliferative 1132 THE NEW ENGLAND JOURNAL OF MEDICINE April 27, 1995 HYDROXYUREA FOR PATIENTS WITH ESSENTIAL THROMBOCYTHEMIA AND A HIGH RISK OF THROMBOSIS SERGIO CORTELAZZO, M.D., GUIDO FINAZZI, M.D., MARCO RUGGERI,

More information

pan-canadian Oncology Drug Review Final Clinical Guidance Report Ruxolitinib (Jakavi) for Polycythemia Vera March 3, 2016

pan-canadian Oncology Drug Review Final Clinical Guidance Report Ruxolitinib (Jakavi) for Polycythemia Vera March 3, 2016 pan-canadian Oncology Drug Review Final Clinical Guidance Report Ruxolitinib (Jakavi) for Polycythemia Vera March 3, 2016 DISCLAIMER Not a Substitute for Professional Advice This report is primarily intended

More information

Recognizing and treating the patient with high-risk polycythemia vera. Kim-Hien Dao, DO, PhD Oregon Health & Science University Portland, Oregon

Recognizing and treating the patient with high-risk polycythemia vera. Kim-Hien Dao, DO, PhD Oregon Health & Science University Portland, Oregon Recognizing and treating the patient with high-risk polycythemia vera Kim-Hien Dao, DO, PhD Oregon Health & Science University Portland, Oregon Disclosure These slides were developed by Incyte Corporation

More information

Increased Number of Red Blood Cells (Polycythemia) Basics

Increased Number of Red Blood Cells (Polycythemia) Basics Increased Number of Red Blood Cells (Polycythemia) Basics OVERVIEW Blood consists of red blood cells (the most numerous cells normally), white blood cells, platelets, and plasma (the liquid portion of

More information

Welcome to Master Class for Oncologists. Session 3: 9:15 AM - 10:00 AM

Welcome to Master Class for Oncologists. Session 3: 9:15 AM - 10:00 AM Welcome to Master Class for Oncologists Session 3: 9:15 AM - 10:00 AM Miami, FL December 18, 2009 Myeloproliferative Neoplasms: Bringing Order to Complexity and Achieving Optimal Outcomes Speaker: Andrew

More information

Polycythemia Vera and Essential Thombocythemia A Single Institution Experience

Polycythemia Vera and Essential Thombocythemia A Single Institution Experience INDIAN JOURNAL OF MEDICAL & PAEDIATRIC ONCOLOGY Vol. 29 No 4, 2008 7 Original Article-I Polycythemia Vera and Essential Thombocythemia A Single Institution Experience CECIL ROSS, NAVYA, VANAMALA AND KARUNA

More information

Polycythemia vera is a clonal disorder of the. Treatment of polycythemia vera. decision making and problem solving TIZIANO BARBUI, GUIDO FINAZZI

Polycythemia vera is a clonal disorder of the. Treatment of polycythemia vera. decision making and problem solving TIZIANO BARBUI, GUIDO FINAZZI Haematologica 1998; 83:143-149 decision making and problem solving Treatment of polycythemia vera TIZIANO BARBUI, GUIDO FINAZZI Department of Hematology, Ospedali Riuniti, Bergamo, Italy Abstract Background

More information

Polycythemia vera treatment algorithm 2018

Polycythemia vera treatment algorithm 2018 Tefferi et al. (2018) 8:3 DOI 10.1038/s41408-017-0042-7 CURRENT TREATMENT ALGORITHM Polycythemia vera treatment algorithm 2018 Ayalew Tefferi 1, Alessandro M. Vannucchi 2 and Tiziano Barbui 3 Open Access

More information

Polycythemia Vera: Aligning Real-World Practices With Current Best Practices

Polycythemia Vera: Aligning Real-World Practices With Current Best Practices Polycythemia Vera: Aligning Real-World Practices With Current Best Practices Overview Ruben A. Mesa, MD, provides practical insights into treating polycythemia vera. In addition to discussing risk stratification,

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

How to treat non-clonal polyglobulia: to bleed or not to bleed. Claire Harrison Guy s and St Thomas Hospitals London, UK

How to treat non-clonal polyglobulia: to bleed or not to bleed. Claire Harrison Guy s and St Thomas Hospitals London, UK How to treat non-clonal polyglobulia: to bleed or not to bleed Claire Harrison Guy s and St Thomas Hospitals London, UK Disclosures Institutional research support: Novartis and Shire Pharmaceuticals Speaker:

More information

Mayo Clinic Treatment Strategy in Essential Thrombocythemia, Polycythemia Vera and Myelofibrosis 2013 Update

Mayo Clinic Treatment Strategy in Essential Thrombocythemia, Polycythemia Vera and Myelofibrosis 2013 Update Mayo Clinic Treatment Strategy in Essential Thrombocythemia, Polycythemia Vera and Myelofibrosis 2013 Update Ayalew Tefferi Mayo Clinic, Rochester, MN 0 20 40 60 80 100 Percent Survival in 337 Mayo Clinic

More information

UTHEALTH HOUSTON CCTS BIOBANK VARIABLE LIST

UTHEALTH HOUSTON CCTS BIOBANK VARIABLE LIST Please check the requested variables:, and/or. Obtained at Initial Hospital Recruitment Demographics: Age Gender Marital Status Ethnicity Race Height (inches) Weight (pounds) Main language spoken Socioeconomic

More information

Aspirin Resistance in Patients with Chronic Renal Failure (P 5325)

Aspirin Resistance in Patients with Chronic Renal Failure (P 5325) Aspirin Resistance in Patients with Chronic Renal Failure (P 5325) Beste Ozben Sadic 1, Azra Tanrikulu 1, Mehmet Koc 2, Tomris Ozben 3, Oguz Caymaz 1 1 Marmara University, Faculty of Medicine, Department

More information

Myelodysplastic Syndromes Myeloproliferative Disorders

Myelodysplastic Syndromes Myeloproliferative Disorders Myelodysplastic Syndromes Myeloproliferative Disorders Myelodysplastic Syndromes characterized by maturation defects that are associated with ineffective hematopoiesis and a high risk of transformation

More information

Research Article Gender and Vascular Complications in the JAK2 V617F-Positive Myeloproliferative Neoplasms

Research Article Gender and Vascular Complications in the JAK2 V617F-Positive Myeloproliferative Neoplasms Thrombosis Volume 2011, Article ID 874146, 8 pages doi:10.1155/2011/874146 Research Article Gender and Vascular Complications in the JAK2 V617F-Positive Myeloproliferative Neoplasms Brady L. Stein, 1 Alfred

More information

Do All Patients With Polycythemia Vera or Essential Thrombocythemia Need Cytoreduction?

Do All Patients With Polycythemia Vera or Essential Thrombocythemia Need Cytoreduction? 1539 Do All Patients With Polycythemia Vera or Essential Thrombocythemia Need Cytoreduction? Kamya Sankar, MD, a and Brady L. Stein, MD, MHS a,b,c Abstract Polycythemia vera (PV) and essential thrombocythemia

More information

Prognostic models in PV and ET

Prognostic models in PV and ET Prognostic models in PV and ET Francesco Passamonti Hematology, Varese, Italy Current risk stratification in PV and ET: statement from European LeukemiaNet consensus Age over 60 years Previuos thrombosis

More information

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant

More information

HORMONE REPLACEMENT THERAPY

HORMONE REPLACEMENT THERAPY TRIALS OF HR RUTH (Barrett- Connor et al 29 ) JULY 2006 (Country) mean ± sd, range International trial 67.5 an Placebo component in 67.5 ± 6.7 women with Raloxifene or multiple 67.5 ± 6.6 risk factors

More information

Polycythemia Vera Facts No. 13 in a series providing the latest information for patients, caregivers and healthcare professionals

Polycythemia Vera Facts No. 13 in a series providing the latest information for patients, caregivers and healthcare professionals No. 13 in a series providing the latest information for patients, caregivers and healthcare professionals www.lls.org Information Specialist: 800.955.4572 Highlights l Polycythemia vera (PV) is one of

More information

2013 Hypertension Measure Group Patient Visit Form

2013 Hypertension Measure Group Patient Visit Form Please complete the form below for 20 or more unique patients meeting patient sample criteria for the measure group for the current reporting year. A majority (11 or more) patients must be Medicare Part

More information

Stroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital

Stroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke

More information

Anticoagulants and Head Injuries. Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar

Anticoagulants and Head Injuries. Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar Anticoagulants and Head Injuries Asaad Shujaa,MD,FRCPC,FAAEM Assistant Professor,weill Corneal Medicne Senior Consultant,HMC Qatar Common Anticoagulants and Indications Coumadin (warfarin) indicated for

More information

GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS

GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS Table of Contents List of authors pag 2 Supplemental figure I pag 3 Supplemental figure II pag 4 Supplemental

More information

Molecular aberrations in MPN. and use in the clinic. Timothy Devos MD PhD

Molecular aberrations in MPN. and use in the clinic. Timothy Devos MD PhD Molecular aberrations in MPN and use in the clinic Timothy Devos MD PhD MB&C2017 24-3-2017 Introduction 1951: William Dameshek MPD MPN = clonal, hematopoietic stem cell disorders, proliferation in BM of

More information

Disclosures for Ayalew Tefferi

Disclosures for Ayalew Tefferi Disclosures for Ayalew Tefferi Principal investigator role Employee Consultant Major Stockholder Speakers Bureau Scientific Advisory Board Janssen, Geron, Celgene, Sanofi-Aventis, Gilead Sciences, Incyte

More information

Which Cyanotic Patient Needs Anticoagulation?

Which Cyanotic Patient Needs Anticoagulation? Which Cyanotic Patient Needs Anticoagulation? Erwin Oechslin, MD, FRCPC, FESC Director, Adult Congenital Heart Disease Program The Bitove Family Professor of ACHD Professor of Medicine, U of T Peter Munk

More information

Platelet and WBC disorders

Platelet and WBC disorders Division of Family Practice Platelet and WBC disorders Adrian Yee MD FRCPC Clinical hematologist Assistant Dean, undergraduate education, IMP asyee@uvic.ca When we understand that slide, we'll have won

More information

MYELOPROLIFERATIVE NEOPLASMS. Matthew Ulrickson, MD Banner MD Anderson Cancer Center September 20, 2016

MYELOPROLIFERATIVE NEOPLASMS. Matthew Ulrickson, MD Banner MD Anderson Cancer Center September 20, 2016 MYELOPROLIFERATIVE NEOPLASMS Matthew Ulrickson, MD Banner MD Anderson Cancer Center September 20, 2016 Matthew.Ulrickson@bannerhealth.com Objectives Discuss an approach to increased cell counts Discuss

More information

Polycthemia Vera (Rubra)

Polycthemia Vera (Rubra) Polycthemia Vera (Rubra) Polycthemia Vera (Rubra) Increased red cells Clonal Myeloid lineages also increased 2-13 cases per million Mean age: 60 years Sites of Involvement Bone marrow Peripheral blood

More information

Leukemia. Roland B. Walter, MD PhD MS. Fred Hutchinson Cancer Research Center University of Washington

Leukemia. Roland B. Walter, MD PhD MS. Fred Hutchinson Cancer Research Center University of Washington Leukemia Roland B. Walter, MD PhD MS Fred Hutchinson Cancer Research Center University of Washington Discussed Abstracts Confirmatory open-label, single-arm, multicenter phase 2 study of the BiTE antibody

More information

COEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE?

COEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE? COEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE? M. DE SLOOVERE (1), L. HARLET (2), S. VAN STEENWEGHEN (3), E. MOREAU (1), D. DE SMET (1) (1) DEPARTMENT OF LABORATORY MEDICINE,

More information

Received: 19 September 2009 / Accepted: 28 December 2009 / Published online: 10 February 2010 # Springer-Verlag 2010

Received: 19 September 2009 / Accepted: 28 December 2009 / Published online: 10 February 2010 # Springer-Verlag 2010 Ann Hematol (2010) 89:691 699 DOI 10.1007/s00277-009-0899-z Author manuscript, published in "Annals of Hematology 89, 7 (2010) 691-699" DOI : 10.1007/s00277-009-0899-z ORIGINAL ARTICLE A retrospective

More information

The Ruxo-BEAT Trial in Patie nts With High-risk Polycythe mia Ve ra or High-risk Esse ntial Thrombocythe mia (Ruxo-BEAT)

The Ruxo-BEAT Trial in Patie nts With High-risk Polycythe mia Ve ra or High-risk Esse ntial Thrombocythe mia (Ruxo-BEAT) A service of the U.S. National Institutes of Health Trial record 2 of 6 for: Ruxolitinib versus best available therapy Previous Study Return to List Next Study The Ruxo-BEAT Trial in Patie nts With High-risk

More information

Polycythemia Vera and other Myeloproliferative Neoplasms. A.Mousavi

Polycythemia Vera and other Myeloproliferative Neoplasms. A.Mousavi Polycythemia Vera and other Myeloproliferative Neoplasms A.Mousavi Chronic MPNs Multipotent hematopoietic progenitor cell is origin. Overproduction of one or more formed element of blood cells without

More information

Ruben A. Mesa, MD & John Camoranio, MD Mayo Clinic

Ruben A. Mesa, MD & John Camoranio, MD Mayo Clinic Arizona, USA Prognosis & MPN Management in 2013 Ruben A. Mesa, MD & John Camoranio, MD Mayo Clinic Arizona, USA Understanding MPN Therapy Options Prognosis and Goals (Mesa & Camoriano) Evolving Rx ET (Vannucchi)

More information

Clinical trials with JAK inhibitors for essential thrombocythemia and polycythemia vera

Clinical trials with JAK inhibitors for essential thrombocythemia and polycythemia vera Clinical trials with JAK inhibitors for essential thrombocythemia and polycythemia vera Alessandro M. Vannucchi, MD Laboratorio Congiunto MMPC Department of Experimental and Clinical Medicine University

More information

Novel drugs in MPNs: Histone-Deacetylase Inhibitors

Novel drugs in MPNs: Histone-Deacetylase Inhibitors Novel drugs in MPNs: HistoneDeacetylase Inhibitors 1st Annual Florence MPN Meeting April 16, 2011 Guido Finazzi Chronic Myeloproliferative Neoplasm Unit Division of Hematology Ospedali Riuniti di Bergamo,

More information

رناد زكريا Dr. ahmad Dr. ahmad. P a g e 1

رناد زكريا Dr. ahmad Dr. ahmad. P a g e 1 5 رناد زكريا Dr. ahmad Dr. ahmad P a g e 1 Before we start. -This sheet was written according to section 2 s record and reviewed according to section 1 s record by Ruba Hussien with all thanks and I referred

More information

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital

More information

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t?

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t? Primary Prevention of Heart Disease: What works? What doesn t? Samia Mora, MD, MHS Associate Professor, Harvard Medical School Associate Physician, Brigham and Women s Hospital October 2, 2015 Financial

More information

(n=6279). Continuous variables are reported as mean with 95% confidence interval and T1 T2 T3. Number of subjects

(n=6279). Continuous variables are reported as mean with 95% confidence interval and T1 T2 T3. Number of subjects Table 1. Distribution of baseline characteristics across tertiles of OPG adjusted for age and sex (n=6279). Continuous variables are reported as mean with 95% confidence interval and categorical values

More information

Accepted Manuscript. To appear in: Clinical Lymphoma, Myeloma and Leukemia. Received Date: 4 June Accepted Date: 21 August 2018

Accepted Manuscript. To appear in: Clinical Lymphoma, Myeloma and Leukemia. Received Date: 4 June Accepted Date: 21 August 2018 Accepted Manuscript Clinical and Disease Characteristics From REVEAL at the Time of Enrollment (Baseline): A Prospective Observational Study of Patients With Polycythemia Vera in the United States Michael

More information

A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS

A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS Magnus Ohman MB, on behalf of the GEMINI-ACS-1 Investigators

More information

Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials

Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La

More information

Leukemic transformation of MPN: Therapy related or unrelated?

Leukemic transformation of MPN: Therapy related or unrelated? Leukemic transformation of MPN: Therapy related or unrelated? Jean Jacques KILADJIAN, MD, PhD Clinical Investigations Center Saint Louis Hospital Paris Diderot University Leukemic transformation: a long

More information

Department of Clinical Haematology

Department of Clinical Haematology Diagnosis in Primary Care and referral pathway for patients with a raised haematocrit Why implement this pathway? A raised haemoglobin or haematocrit is a common finding and can be a reason for referral.

More information

Disclosure BCR/ABL1-Negative Classical Myeloproliferative Neoplasms

Disclosure BCR/ABL1-Negative Classical Myeloproliferative Neoplasms Disclosure BCR/ABL1-Negative Classical Myeloproliferative Neoplasms Sonam Prakash declares affiliation with Incyte Corporation: Advisor for Hematopathology Publications Steering Committee Sonam Prakash,

More information

Treatment of polycythemia vera with recombinant interferon alpha (rifnα)

Treatment of polycythemia vera with recombinant interferon alpha (rifnα) Treatment of polycythemia vera with recombinant interferon alpha (rifnα) Richard T. Silver, MD Professor of Medicine Weill Cornell Medical College New York, New York Outline of Lecture What are interferons?

More information

POLYCYTHEMIA VERA (PV)

POLYCYTHEMIA VERA (PV) LIVING WITH POLYCYTHEMIA VERA (PV) Information, resources, and support for wherever you are on your journey with PV. For more information, visit PVvoices.com today. POLYCYTHEMIA VERA (polly-sigh-thee-me-ah-vair-ah)

More information

Disclosures. Dr. Scirica has also served as a consultant for Lexicon, Arena, Gilead, and Eisai.

Disclosures. Dr. Scirica has also served as a consultant for Lexicon, Arena, Gilead, and Eisai. Disclosures Benjamin M. Scirica, MD, MPH, is employed by the TIMI Study Group, which has received research grants from Abbott, AstraZeneca, Amgen, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb,

More information

PRECISION: A Canadian In-practice Needs Assessment in Management of PV in Canada* Expert Consensus Recommendations

PRECISION: A Canadian In-practice Needs Assessment in Management of PV in Canada* Expert Consensus Recommendations PRECISION: A Canadian In-practice Needs Assessment in Management of PV in Canada* Expert Consensus Recommendations *This program was made possible through funding from Novartis Pharmaceuticals Canada.

More information

Table 1 Baseline characteristics of 60 hemodialysis patients with atrial fibrillation and warfarin use

Table 1 Baseline characteristics of 60 hemodialysis patients with atrial fibrillation and warfarin use Table 1 Baseline characteristics of 60 hemodialysis patients with atrial fibrillation and warfarin use Baseline characteristics Users (n = 28) Non-users (n = 32) P value Age (years) 67.8 (9.4) 68.4 (8.5)

More information

An elevated hematocrit or platelet count in an otherwise

An elevated hematocrit or platelet count in an otherwise The Rate of Progression to Polycythemia Vera or Essential Thrombocythemia in Patients with Erythrocytosis or Thrombocytosis Marco Ruggeri, MD; Alberto Tosetto, MD; Maurizio Frezzato, MD; and Francesco

More information

Chemistry Reference Ranges and Critical Values

Chemistry Reference Ranges and Critical Values Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-25 U/L 10-35 U/L 10-30 U/L 10-25 U/L 10-30 U/L 10-35 U/L 10-25 U/L 10-35 U/L 10-25 U/L 10-20 U/L 10-35 U/L Albumin 0-6

More information

Chemistry Reference Ranges and Critical Values

Chemistry Reference Ranges and Critical Values Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-30 U/L 10-30 U/L 10-20 U/L Albumin 0-6 days 6 days - 37 months 37 months - 7 years 7-20 years 2.6-3.6 g/dl 3.4-4.2 g/dl

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

MYELODYSPLASTIC AND MYELOPROLIFERATIVE

MYELODYSPLASTIC AND MYELOPROLIFERATIVE MYELODYSPLASTIC AND MYELOPROLIFERATIVE DISORDERS Pediatric Hemato-Oncology Division Medical Faculty University of Sumatera Utara 1 MYELODYSPLASIA SYNDROME A group of disorder defect in hematopoetic cell

More information

Guidelines on cardiovascular risk assessment and management

Guidelines on cardiovascular risk assessment and management European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi:10.1093/eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine

More information

2013 Pathology Student

2013 Pathology Student About this guide If you re reading this introduction, it means you are probably either a) covering hematopathology in your pathology class right now, or b) studying for boards. Either way, you ve come

More information

Small dense low-density lipoprotein is a risk for coronary artery disease in an urban Japanese cohort: The Suita study

Small dense low-density lipoprotein is a risk for coronary artery disease in an urban Japanese cohort: The Suita study Small dense low-density lipoprotein is a risk for coronary artery disease in an urban Japanese cohort: The Suita study Hidenori Arai 1, Yoshihiro Kokubo 2, Makoto Watanabe 2, Tatsuya Sawamura 3, Tomonori

More information

Polycytemia Vera, Essential Thrombocythemia and Myelofibrosis: prognosis and treatment

Polycytemia Vera, Essential Thrombocythemia and Myelofibrosis: prognosis and treatment Polycytemia Vera, Essential Thrombocythemia and Myelofibrosis: prognosis and treatment BHS Training course 2013-2015 Timothy Devos POLYCYTEMIA VERA PV: clinical manifestations thrombosis (art > ven) facial

More information

Bone marrow histopathology in Ph - CMPDs. - the new WHO classification - Juergen Thiele Cologne, Germany

Bone marrow histopathology in Ph - CMPDs. - the new WHO classification - Juergen Thiele Cologne, Germany Bone marrow histopathology in Ph - CMPDs - the new WHO classification - Juergen Thiele Cologne, Germany Current issues in MPNs concerning morphology 1.Prodromal stages of disease 2.Impact of histopathology

More information

Lupus as a risk factor for cardiovascular disease

Lupus as a risk factor for cardiovascular disease Lupus as a risk factor for cardiovascular disease SØREN JACOBSEN Department Rheumatology, Rigshospitalet Søren Jacobsen Main sponsors: Gigtforeningen Novo Nordisk Fonden Rigshospitalet Disclaimer: Novo

More information

Introduction. Objective. Critical Questions Addressed

Introduction. Objective. Critical Questions Addressed Introduction Objective To provide a strong evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men Critical Questions Addressed CQ1:

More information

Controversies in Cardiac Pharmacology

Controversies in Cardiac Pharmacology Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?

More information

Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center

Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes

More information

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

PRASUGREL HYDROCHLORIDE (Effient Eli Lilly Canada Inc.) Indication: Acute Coronary Syndrome

PRASUGREL HYDROCHLORIDE (Effient Eli Lilly Canada Inc.) Indication: Acute Coronary Syndrome CEDAC FINAL RECOMMENDATION PRASUGREL HYDROCHLORIDE (Effient Eli Lilly Canada Inc.) Indication: Acute Coronary Syndrome Recommendation: The Canadian Expert Drug Advisory Committee (CEDAC) recommends that

More information

Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy. Ziad Hijazi, MD

Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy. Ziad Hijazi, MD Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy Ziad Hijazi, MD Uppsala Clinical Research Center (UCR) Uppsala University, Sweden Co-authors:

More information

Essential thrombocythemia treatment algorithm 2018

Essential thrombocythemia treatment algorithm 2018 Tefferi et al. (2018) 8:2 DOI 10.1038/s41408-017-0041-8 CURRENT TREATMENT ALGORITHM Essential thrombocythemia treatment algorithm 2018 Ayalew Tefferi 1, Alessandro M. Vannucchi 2 and Tiziano Barbui 3 Open

More information

Hematologic Disorders. Assistant professor of anesthesia

Hematologic Disorders. Assistant professor of anesthesia Preoperative Evaluation Hematologic Disorders Dr M.Razavi Assistant professor of anesthesia Anemia Evaluation needs to consider the extent and type of surgery, the anticipated blood loss, and the patient's

More information

LAB TIME/DATE. 1. most numerous leukocyte. 3. also called an erythrocyte; anucleate formed element. 6. ancestral cell of platelets

LAB TIME/DATE. 1. most numerous leukocyte. 3. also called an erythrocyte; anucleate formed element. 6. ancestral cell of platelets ighapmlre29apg245_250 5/12/04 2:46 PM Page 245 impos03 302:bjighapmL:ighapmLrevshts:layouts: NAME Blood LAB TIME/DATE REVIEW SHEET exercise 29A Composition of Blood 1. What is the blood volume of an average-size

More information

Polycythemia vera: Emerging diagnostic and risk stratification criteria

Polycythemia vera: Emerging diagnostic and risk stratification criteria This article, sponsed by Incyte Cpation, is based on a paid interview with Rami S. Komrokji, MD, of Moffitt Cancer Center, Tampa, Flida, conducted on May 4, 2015. Polycythemia vera: Emerging diagnostic

More information