Houghton Damon E, Key Nigel S, Zakai Neil A, Laux Jeffrey P, Shea Thomas C, Moll Stephan
a Department of Medicine, Division of Hematology/Oncology , University of North Carolina , Chapel Hill , NC , USA.
b Departments of Medicine and Pathology , University of Vermont , Burlington , VT , USA.
Leuk Lymphoma. 2017 Nov;58(11):2573-2581. doi: 10.1080/10428194.2017.1306644. Epub 2017 Apr 9.
The safety and efficacy of anticoagulation for venous thromboembolism (VTE) at times of severe thrombocytopenia is unclear. In this retrospective study, we evaluated patients with hematologic malignancy and either (1) acute or chronic VTE on anticoagulation before platelet count dropped below 50 × 10/L or (2) acute VTE occurring while platelets were <50 × 10/L. In 78 eligible patients, the primary outcomes of time to recurrent VTE or clinically significant bleeding within 100 d were compared by management strategy. Bleeding occurred in 27% of patients receiving anticoagulation versus 3% when anticoagulation was held (IRR 10.1, 95% CI 1.5-432.6). Recurrent VTE occurred in 2% of patients receiving anticoagulation versus 15% when anticoagulation was held (IRR 0.17, 95% CI 0.0-1.51). Most bleeding occurred before day 31(11/13), but recurrent VTE mostly occurred after day 40 (5/6). Our findings suggest that temporarily withholding anticoagulation for VTE during severe thrombocytopenia in patients with hematologic malignancies might reduce adverse outcomes.
在严重血小板减少症患者中，抗凝治疗静脉血栓栓塞症（VTE）的安全性和有效性尚不清楚。在这项回顾性研究中，我们评估了血液系统恶性肿瘤患者，这些患者要么（1）在血小板计数降至低于50×10⁹/L之前正在接受抗凝治疗的急性或慢性VTE，要么（2）血小板计数<50×10⁹/L时发生急性VTE。在78例符合条件的患者中，通过管理策略比较了100天内复发性VTE或临床显著出血的主要结局。接受抗凝治疗的患者中有27%发生出血，而停止抗凝治疗时这一比例为3%（发生率比10.1，95%置信区间1.5-432.6）。接受抗凝治疗的患者中有2%发生复发性VTE，而停止抗凝治疗时这一比例为15%（发生率比0.17，95%置信区间0.0-1.51）。大多数出血发生在第31天之前（11/13），但复发性VTE大多发生在第40天之后（5/6）。我们的研究结果表明，在血液系统恶性肿瘤患者严重血小板减少期间，暂时停用抗凝治疗VTE可能会减少不良结局。
