We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.

CRIMM Center of Research and Innovation of Myeloproliferative Neoplasms Azienda Ospedaliera Universitaria Careggi and Departmentt Experimental and Clinical Medicine University of Florence Firenze Italy

Department of Clinical and Experimental Medicine University of Catania Catania Italy

Department of Hemato Oncology Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Hematology Oncology Fondazione IRCCS Policlinico San Matteo Pavia Italy

Department of Medical Surgical and Advanced Technologies Sciences G F Ingrassia University of Catania Catania Italy

Department of Medicine DIMED University of Padua Padova Italy

Department of Medicine Section of Hematology University of Verona Verona Italy

Department of Molecular Medicine University of Pavia Pavia Italy

Division of Hematology Department of Translational Medicine University of Eastern Piedmont Novara Italy

Division of Hematology Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva Policlinico G Martino University of Messina Messina Italy

Divisione di Ematologia Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy

FROM Research Foundation Papa Giovanni XXIII hospital Bergamo Italy

Hematology and Bone Marrow Transplantation Unit IRCCS San Raffaele Scientific Institute Milano Italy

Hematology Department Hospital Clínico Universitario Valencia Spain

Hematology Department Ospedale San Bortolo Vicenza Italy

Hematology Division IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation and University of Milan Milan Italy

Hematology Division Ospedale San Gerardo ASST Monza Monza Italy

Hematology Division Papa Giovanni XXIII hospital Bergamo Italy

Hematology Institute and Blood Bank Meir Medical Center Kfar Saba and Sackler School of Medicine Tel Aviv University Tel Aviv Israel

Hospital Clínic IDIBAPS University of Barcelona Barcelona Spain

Institute of Hematology Catholic University Fondazione Policlinico Universitario A Gemelli Roma Italy

Institute of Hematology L and A Seràgnoli S Orsola Malpighi Hospital Bologna Italy

Neurology Division Papa Giovanni XXIII hospital Bergamo Italy

S C Ematologia Azienda Ospedaliera S Croce e Carle Cuneo Italy

Unit of Hematology Department of Oncology University of Torino Torino Italy

Unit of Neurology Neurophysiology Neurobiology Department of Medicine Università Campus Biomedico di Roma Rome Italy

University Clinic for Hematology and Oncology Minden University of Bochum Bochum Germany

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