The impact of sodium-glucose cotransporter-2 inhibitors on thrombosis and cardiovascular disease in patients with polycythemia vera or essential thrombocytopenia

BackgroundPolycythemia vera (PV) and Essential thrombocytopenia (ET) are characterized by a high risk of thrombotic and cardiovascular events. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with a thromboreductive and cardioprotective effect in patients with Type 2 Diabetes Mellitus (T2DM). We aimed to evaluate the effects of SGLT2i on outcomes of patients with PV or ET.MethodsWe carried out a retrospective, propensity score-matched cohort study using the TriNetX Analytics Network database, which comprises de-identified electronic health records from more than 120 healthcare organizations. We included patients with T2DM who had a diagnosis of PV or ET. Patients on SGLT2i were compared to patients on non-SGLT2i diabetes agents. The primary outcomes were venous thromboembolism (VTE), defined as a composite of pulmonary embolism and deep venous thrombosis, and MACE, defined as a composite of heart failure, myocardial infarction, and atrial fibrillation. The safety outcomes were all-cause mortality and adverse events that have been associated with SGLT2i.ResultsWe identified 17392 patients eligible for analysis, of which 1039 patients on an SGLT2i were matched to patients not on an SGLT2i. In Cox proportional hazards analyses, the SGLT2i cohort had a similar risk of composite VTE and MACE as the non-SGLT2i cohort. In terms of individual events, patients on an SGLT2i had a lower risk of heart failure (Hazard ratio (HR), 0.68 [95% CI: (0.49-0.94)]) and deep vein thrombosis (HR, 0.47 [95% CI: 0.23-0.97]) as compared to patients on a non-SGLT2i. The use of SGLT2i were associated with a lower all-cause mortality (HR, 0.42 [95% CI: 0.31-0.57]) without an increase in safety events. Table: 1860P Outcomes Hazard ratio (95% CI) Efficacy outcomes Venous thromboembolism 0.74 (0.43-1.29) Pulmonary embolism 1.06 (0.54-2.08) Deep vein thrombosis 0.47 (0.23-0.97) MACE 0.83 (0.61-1.14) Heart failure 0.68 (0.49-0.94) Myocardial infarction 0.72 (0.44-1.19) Atrial fibrillation 0.81 (0.52-1.25) Safety outcomes All-cause mortality 0.42 (0.31-0.57) Acute kidney injury 0.55 (0.40-0.77) Urinary tract infection 0.55 (0.38-0.81) Hypoglycemia 0.67 (0.39-1.15) Diabetic ketoacidosis 0.32 (0.14-0.76) ConclusionsThe use of SGLT2i was associated with a reduction in heart failure, deep venous thrombosis, and mortality among patients with T2DM and PV or ET.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.