Imberti Davide, Vallisa Daniele, Anselmi Elisa, Moroni Carlo Filippo, Bertè Raffaella, Lazzaro Antonio, Bernuzzi Patrizia, Arcari Anna Lisa, Cavanna Luigi
Third Internal Medicine Unit and Medical Oncology and Haematology, Civic Hospital, Piacenza, Italy.
Tumori. 2004 Jul-Aug;90(4):390-3. doi: 10.1177/030089160409000405.
Venous thromboembolism (VTE) is a quite common complication in acute leukemia, although its real incidence is unknown. The best treatment of this complication is still a matter of debate due to the very high risk of hemorrhage in this group of patients.
From December 2000 to December 2002 four Caucasian patients with acute leukemia developed VTE complications. The patients were three men and one woman, mean age 55.7 years (range, 27-77). Two patients with acute lymphoid leukemia (L1 and L2 according to the FAB classification) developed deep venous thrombosis during the administration of chemotherapy; one patient with acute myeloid leukemia (AML, M2 according to the FAB classification) had pulmonary thromboembolism at diagnosis, while another AML patient (M4 according to FAB) showed deep venous thrombosis as the first symptom of leukemia. The clinical diagnosis of symptomatic VTE was confirmed by objective imaging procedures including lower limb venous color Doppler imaging in all cases and a ventilation-perfusion lung scan in one case. All patients were treated with enoxaparin 100 IU/kg subcutaneously twice daily for one month, followed by 150 IU/kg once daily for at least five months. When the platelet count was below 20,000 x 10(9)/L, the dose was reduced by 50%.
During antithrombotic treatment neither VTE recurrences nor hemorrhagic complications or heparin-induced thrombocytopenia occurred. The platelet count at the beginning of enoxaparin treatment was very low (mean, 55,750 x 109/L; range, 12,000-121,000 x 10(9)/L) and treatment did not affect platelet recovery.
Enoxaparin proved to be efficacious and safe in the management of deep venous thrombosis with or without pulmonary embolism in patients affected by acute leukemia. Enoxaparin cured acute venous thrombosis, prevented recurrences and did not cause any hemorrhagic complications despite prolonged severe thrombocytopenia.
静脉血栓栓塞症（VTE）是急性白血病中一种相当常见的并发症，尽管其实际发病率尚不清楚。由于这类患者出血风险极高，该并发症的最佳治疗方法仍存在争议。
2000年12月至2002年12月期间，4名白种急性白血病患者发生了VTE并发症。患者为3名男性和1名女性，平均年龄55.7岁（范围27 - 77岁）。两名急性淋巴细胞白血病患者（根据FAB分类为L1和L2）在化疗期间发生了深静脉血栓形成；一名急性髓系白血病患者（根据FAB分类为AML，M2）在诊断时发生了肺血栓栓塞，而另一名AML患者（根据FAB分类为M4）表现为深静脉血栓形成作为白血病的首发症状。有症状VTE的临床诊断通过客观影像学检查得以证实，所有病例均进行了下肢静脉彩色多普勒成像，1例进行了通气 - 灌注肺扫描。所有患者均接受依诺肝素皮下注射，剂量为100 IU/kg，每日两次，持续1个月，随后为150 IU/kg，每日一次，至少持续5个月。当血小板计数低于20,000×10⁹/L时，剂量减少50%。
在抗血栓治疗期间，未发生VTE复发、出血并发症或肝素诱导的血小板减少症。依诺肝素治疗开始时血小板计数非常低（平均55,750×10⁹/L；范围12,000 - 121,000×10⁹/L），且治疗未影响血小板恢复。
依诺肝素在治疗急性白血病患者伴有或不伴有肺栓塞的深静脉血栓形成方面被证明是有效且安全的。依诺肝素治愈了急性静脉血栓形成，预防了复发，并且尽管存在长期严重血小板减少症，但未引起任何出血并发症。
