# Post‐Diagnosis Hemorrhagic Events Are Strongly Associated With Poor Survival in Patients With Essential Thrombocythemia

## TL;DR

Hemorrhagic events after diagnosis strongly predict poor survival in essential thrombocythemia patients.

## Contribution

This study identifies hemorrhagic events as a critical risk factor for early death in essential thrombocythemia.

## Key findings

- Hemorrhagic events significantly increase mortality risk (hazard ratio = 2.92).
- Hemorrhagic events have higher transition hazards to death compared to other conditions.
- Preventing intermediate statuses like hemorrhage may improve survival in ET patients.

## Abstract

The present study investigated the effects of thrombosis, hemorrhagic events, disease progression, and secondary malignancies on patient survival after the diagnosis of essential thrombocythemia (ET).

We analyzed data from 1152 patients enrolled in the JSH‐MPN‐18 study using time‐dependent Cox regression and multistate Markov models to estimate transition hazards and state occupation probabilities.

Hemorrhagic events (hazard ratio = 2.92, 95% confidence interval = 1.78–4.78, p < 0.001) was associated with a poor prognosis. In multistate model, hazards from the hemorrhagic event to death were higher among cumulative transition hazards, and the probability of remaining in the hemorrhagic state was lower than the probability of remaining in the other states of thrombosis, disease progression, and secondary malignancy in state occupancy probabilities.

The present results demonstrated that hemorrhagic events following the diagnosis of ET are a serious risk factor and are directly related to early death. Baseline characteristics and post‐diagnosis events (intermediate status) may both have a significant impact on survival, and treatment strategies that take into account the prevention of an intermediate status need to be incorporated into clinical practice.

The authors have confirmed clinical trial registration is not needed for this submission.