# Clinical and Molecular Insights of Arterial and Venous Thrombosis in Myeloproliferative Diseases—Case-Based Narrative Review

## TL;DR

This paper reviews the clinical and genetic aspects of thrombosis in myeloproliferative neoplasms, using a rare case to guide treatment approaches.

## Contribution

The paper provides novel clinical insights through a rare case of extensive MPN-associated thrombosis and treatment strategies.

## Key findings

- Arterial and venous thrombosis affects 40–50% of MPN patients and is linked to severe outcomes like myelofibrosis and cancer.
- A rare case of MPN-associated thrombosis highlights the need for a multidisciplinary treatment approach.
- Medical and surgical treatments were used for multiple thrombi in a complex MPN case.

## Abstract

The myeloproliferative neoplasms (MPN), a heterogeneous group of disorders characterized by specific genetic mutations, have the development of arterial and venous thrombosis as their main complication. Almost 40–50% of MPN patients encountered arterial or venous thrombosis during the course of their disease. Moreover, arterial thrombosis is linked to significant mortality, progression to myelofibrosis, and an increased risk of developing second cancers. Despite significant advancements in medical research, there are still unmet needs in this field. Our narrative review provides clinical and genetic insights into thrombosis associated with myeloproliferative neoplasms. We focus on the underlying pathophysiological processes, assessment methods, and risk stratification related to thrombotic events. This information aims to assist clinicians in accurately assessing the risks associated with MPN thrombosis, enabling a more personalized and effective approach to patient care. We based our review on a rare case of MPN-associated thrombosis, whose clinical presentation was marked by acute ischemia in both lower limbs. The thrombosis affected the distal aortic arch, thoracic and abdominal aorta, celiac trunk, common and proper hepatic arteries, proximal left renal artery, several segmental arteries in the right kidney, and the portal vein thrombosis. Our review presents various therapeutic options for these conditions. In the presented case, the multiple thrombi were treated medically, except for the popliteal artery thromboses, which required surgical management. This case may serve as a valuable reference for choosing treatment options for aortic and portal vein thrombosis, highlighting the multidisciplinary approach.