The risk of AML/MDS development after MPN diagnosis was significantly associated with high exposures of P(32) and alkylators but not with HU treatment. Twenty-five percent of patients with MPNs who developed AML/MDS were not exposed to cytotoxic therapy, supporting a major role for nontreatment-related factors.

Background: Among patients with chronic immune thrombocytopenia (cITP), little is known regarding risk factors for cardiovascular and bleeding outcomes and how these events influence mortality. Objectives:We examined the rate of cardiovascular events and bleeding requiring a hospital contact according to platelet count levels, as well as the prognostic impact of these events on all-cause mortality in adult patients with cITP. Methods: We identified all cITP patients registered in the Nordic Country PatientRegistry for Romiplostim during 1996 to 2015. Absolute risks and hazard ratios across platelet count levels based on Cox regression analysis were computed, adjusting for age, sex, prevalent/incident cITP, smoking, and comorbidities. We also compared all-cause mortality rates in cITP patients with and without cardiovascular and bleeding events.Results: Among 3 584 cITP patients, 1-year risks were 1.9% for arterial cardiovascular events, 1.2% for venous thromboembolism, and 7.5% for bleeding. Rates of cardiovascular events were similar across platelet counts. Patients with platelet counts <50 × 10 9 /L had >2-fold higher rates of bleeding than patients with normal platelet counts. These associations were unchanged in time-varying analyses that considered changes in platelet counts during follow-up. Occurrences of cardiovascular and bleeding events were associated with 4-fold to 5-fold increases in 1-year mortality. Conclusions:Among patients with cITP, the 1-year risks of cardiovascular events were 1% to 2%, while nearly 8% experienced a bleeding event within 1 year.Cardiovascular events occurred across all platelet levels, while low platelet counts were associated with increased hazards of bleeding. Cardiovascular and bleeding events were strong prognostic factors for mortality. K E Y W O R D Sbleeding, chronic ITP, epidemiology, mortality, stroke, myocardial infarction, venous thromboembolism | 913 ADELBORG Et AL.

In a retrospective study of 155 cases of feline dystocia, 67.1 per cent were of maternal origin, mainly caused by uterine inertia, while 29.7 per cent were of fetal origin, mainly resulting from malpresentations/malorientations and deformities. Its breed incidence was somewhat higher in Persian cats than in other breeds and considerably lower in Norwegian forest cats. Litter size was not related to the risk of developing dystocia. Ninety-seven cats (62.5 per cent) were treated with calcium and, or, oxytocin. Medical treatment was successful in only 29 cases (29.9 per cent). Caesarean sections were performed on '123 (79.4 per cent) of the cats that were brought to the hospital because of dystocia. In 55 cases (35.5 per cent) a caesarean section was performed without prior attempts at medical treatment.

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Background: Population-based cohorts of immune thrombocytopenia (ITP) are useful for understanding occurrence, clinical characteristics and long-term clinical course. This paper describes the content of the Nordic Country Patient Registry for Romiplostim (NCPRR) and provides prevalence and incidence estimates of chronic ITP (cITP). Methods: The NCPRR, a cohort study established in 2009, includes all adult (18 years) patients in Denmark, Sweden and Norway with cITP (defined as ITP lasting >12 months and platelet count <100 £ 10 9 /L), combining data from national health registries and medical records. The NCPRR currently includes prevalent cITP patients diagnosed before 2009 and incident cITP patients diagnosed during 2009À2016. The registry obtains clinical information for cITP patients, including comorbidities, treatments, laboratory values, and complete follow-up for various outcomes. Findings: The NCPRR currently includes 3831 patients with cITP (1258 prevalent; 2573 incident). In 2009, the prevalence of registered cITP was 10 ¢0/100,000 (95%CI:9 ¢1À11 ¢0) adult persons in Denmark and 10¢ 7/ 100,000 (95% CI: 9¢9À11 ¢4) adults in Sweden. During 2009À2016, the incidence rates of cITP per 100,000 person-years were 2¢8 (95%CI: 2¢6À3¢0), 1¢8 (95%CI: 1¢ 7À1¢9) and 2¢1 (95%CI: 1¢ 9À2¢2) in Denmark, Sweden and Norway, respectively. Fifty-eight percent of cITP patients were women. At NCPRR inclusion, 30.2% were aged 70 years, 23% had a platelet count < 50 £ 10 9 /L, 17.4% were splenectomized, 41% had prior ITP therapy, and 8.6% had severe comorbidity. Interpretation: The NCPRR provides population-based data on the epidemiology and characteristics of almost 4000 cITP patients and is a valuable resource for research. Funding: This study was partly funded by a research grant from Amgen to Aarhus University.

Patients with cITP have increased risks of infection and anti-infective treatments before their cITP diagnosis, with a more marked risk for candidiasis and viral infections. The findings indicate that infection is not only related to the immunomodulation treatment but also to the disease itself.

We aimed to assess the risk factors of venous thrombosis (VT) and arterial thrombosis (AT) in adults with primary immune thrombocytopenia (ITP), particularly in relation to treatments. The population comprised all incident primary ITP adults in France between 2009 and 2017 (FAITH cohort; NCT03429660) built in the national health database. Outcomes were the first hospitalisation for VT and AT. Multivariable Cox regression models included baseline risk factors, time-varying exposure to ITP drugs, splenectomy and to cardiovascular drugs. The cohort included 10 039 patients. A higher risk of hospitalisation for VT was observed with older age, history of VT, history of cancer, splenectomy [hazard ratio (HR) 3Á23, 95% confidence interval (CI) 2Á26-4Á61], exposure to corticosteroids (HR 3Á55, 95% CI 2Á74-4Á58), thrombopoietin-receptor agonists (TPO-RAs; HR 2Á28, 95% CI 1Á59-3Á26) and intravenous immunoglobulin (IVIg; HR 2Á10, 95% CI 1Á43-3Á06). A higher risk of hospitalisation for AT was observed with older age, male sex, a history of cardiovascular disease, splenectomy (HR 1Á50, 95% CI 1Á12-2Á03), exposure to IVIg (HR 1Á85, 95% CI 1Á36-2Á52) and TPO-RAs (HR 1Á64, 95% CI 1Á26-2Á13). Rituximab was not associated with an increased risk. These findings help to estimate the risk of thrombosis in adult patients with ITP and to select treatment.

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