Serious cardiovascular adverse effects, including cases of cardiomyopathy, cardiomegaly, congestive heart failure and cardiac arrhythmias, have been reported in patients treated with anagrelide, including those without suspected heart disease or abnormal cardiovascular findings before treatment. This had led to a review of all cardiac adverse events in patients <50 years of age treated with the drug. As a result, the manufacturer has highlighted the following:
- Anagrelide should be used with caution in patients of any age with known or suspected heart disease.
- All patients should be monitored before and during treatment for signs and symptoms of cardiovascular effects that may require further cardiovascular examination.
Use only as second line therapy
Healthcare professionals are also reminded that anagrelide should be used only as second-line therapy in at-risk patients with essential thrombocythaemia, defined as one or more of the following characteristics:
- Age >60 years or
- Platelet count >1000 x 109/L or
- History of thrombo-haemorrhagic events.