A Meta-analysis Of The Risk Of Thrombosis, Hemorrhage, And Disease Transformation In The Treatment Of Essential Thrombocythemia With Anagrelide

Objective:To systematically evaluate the risk of thrombosis,hemorrhage,and disease transformation in essential thrombocythemia(ET)with anagrelide and other cytoreductive therapy.Methods:Chinese and English databases such as Pub Med,The Cochrane Library,Embase,China Journal Full-text Database(CNKI),Wanfang database,Weipu database are searched by computer.The search time is limited to the self-built database to December 2019.All the retrieved literature are based on the inclusion and exclusion criteria and include therapeutic method,incidence of venous thrombosis,incidence of arterial thrombosis,incidence of hemorrhage,transformation rate of acute leukemia and myelodysplastic syndrome,transformation rate of myelofibrosis in patients with essential thrombocythemia.The statistical analysis was processed by Review Manager 5.3software.Results:A total of 206 references were retrieved and 5 were eventually included,including4848 subjects,1489 in the anagrelide treatment group and 3359 in the other cytoreductive therapy group.There are no significant difference in the incidence of arterial thrombosis(OR=0.70,95%Cl 0.31~1.60)and acute leukemia/myelodysplastic syndrome transformation rate(OR=0.35,95%Cl 0.08~1.41)in patients with essential thrombocytopenia between anagrelide and other cytoreductive therapy.Anagrelide is more likely to cause hemorrhage(OR=2.05,95%Cl 1.46~2.90)and make patients transform into myelofibrosis(OR=3.22,95%Cl 2.03~5.12)in patients with essential thrombocytopenia than other cytoreductive therapy,and other cytoreductive therapy is more likely to cause venous thrombosis(OR=0.32,95% Cl 0.20~0.50)than anagrelide.Conclusion:There was no significant difference in the risk of arterial thrombosis and transformation of acute leukemia/myelodysplastic syndrome in patients with essential thrombocytopenia treated with anagrelide compared with other cytoreductive therapy.Those who used anagrelide had a higher risk of hemorrhage and transformation of myelofibrosis,while those who used other cytoreductive therapy had a higher risk of venous thrombosis.