Niesvizky Ruben, Martínez-Baños Déborah, Jalbrzikowski Jessica, Christos Paul, Furst Jessica, De Sancho Maria, Mark Tomer, Pearse Roger, Mazumdar Madhu, Zafar Faiza, Pekle Karen, Leonard John, Jayabalan David, Coleman Morton
Center of Excellence for Lymphoma and Myeloma, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
Leuk Lymphoma. 2007 Dec;48(12):2330-7. doi: 10.1080/10428190701647887.
Multiple myeloma (MM) patients have a propensity for thromboembolic events (TE), and treatment with thalidomide/dexamethasone or lenalidomide/dexamethasone increases this risk. This report describes the use of low-dose aspirin (81 mg) as primary thromboprophylaxis in three series of MM patients receiving thalidomide or lenalidomide with other drugs. In the first regimen (clarithromycin, thalidomide, dexamethasone), initiation of low-dose aspirin negated the occurrence of any further TE. In a second study, prophylactic aspirin given with thalidomide/dexamethasone resulted in a rate of TE similar to that seen with dexamethasone alone (without aspirin). A third study (n = 72) evaluated thrombosis rates with aspirin and a lenalidomide-containing regimen (clarithromycin, lenalidomide, dexamethasone). Of nine occurrences of thromboembolism, five were associated with aspirin interruption or poor compliance. Low-dose aspirin appears to reduce the incidence of thrombosis with these regimens. Routine use of aspirin as antithrombotic prophylaxis in MM patients receiving immunomodulatory drugs with corticosteroids is warranted.
多发性骨髓瘤（MM）患者有发生血栓栓塞事件（TE）的倾向，使用沙利度胺/地塞米松或来那度胺/地塞米松治疗会增加这种风险。本报告描述了在三组接受沙利度胺或来那度胺联合其他药物治疗的MM患者中，使用低剂量阿司匹林（81毫克）作为主要血栓预防措施的情况。在第一种治疗方案（克拉霉素、沙利度胺、地塞米松）中，开始使用低剂量阿司匹林可避免进一步发生任何TE。在第二项研究中，与沙利度胺/地塞米松联合使用的预防性阿司匹林导致的TE发生率与单独使用地塞米松（不使用阿司匹林）时相似。第三项研究（n = 72）评估了使用阿司匹林和含来那度胺方案（克拉霉素、来那度胺、地塞米松）时的血栓形成率。在九次血栓栓塞事件中，有五次与阿司匹林中断或依从性差有关。低剂量阿司匹林似乎可降低这些方案的血栓形成发生率。对于接受免疫调节药物联合糖皮质激素治疗的MM患者，有必要常规使用阿司匹林作为抗血栓预防措施。
