Ianotto Jean-Christophe, Couturier Marie-Anne, Galinat Hubert, Mottier Dominique, Berthou Christian, Guillerm Gaëlle, Lippert Eric, Delluc Aurélien
Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France.
INSERM EA-3878, GETBO (Groupe d'étude de la thrombose en Bretagne occidentale), CHRU de Brest, Brest, France.
Int J Hematol. 2017 Oct;106(4):517-521. doi: 10.1007/s12185-017-2282-5. Epub 2017 Jun 16.
Direct oral anticoagulants (DOACs) have been approved to treat and prevent thrombotic events. However, they are not yet labeled for use in patients with active cancers. Myeloproliferative neoplasms (MPNs) are clonal chronic disorders with a high incidence of thrombotic events, for which low-dose aspirin (LDA) is the standard drug treatment. We analyzed efficacy and safety of DOACs prescription in patients treated for MPNs. An MPN database, the OBENE registry, was established at our institution. We collected biological and clinical data from diagnosis to last follow-up for every patient included in this study. Thrombotic and hemorrhagic events and hematologic evolutions were categorized as major events in the database. Of the 760 MPN patients in the OBENE registry, 25 (3.3%) were treated with a DOAC. Median follow-up duration was 2.1 years (0.12-4.3 years). The reasons for prescribing DOACs were atrial fibrillation and thrombotic events for 13 and 12 patients, respectively. We only observed one thrombotic event (4%) and three major hemorrhagic events (12%). A case-control study did not detect a significant difference in thrombotic or hemorrhagic events in patients treated with LDA and DOACs. These preliminary results suggest that DOACs may be highly efficient and safe for use in MPN patients.
直接口服抗凝剂（DOACs）已被批准用于治疗和预防血栓形成事件。然而，它们尚未被批准用于患有活动性癌症的患者。骨髓增殖性肿瘤（MPNs）是具有高血栓形成事件发生率的克隆性慢性疾病，低剂量阿司匹林（LDA）是其标准药物治疗。我们分析了DOACs处方在接受MPNs治疗的患者中的疗效和安全性。我们机构建立了一个MPN数据库，即OBENE注册库。我们收集了本研究中纳入的每位患者从诊断到最后随访的生物学和临床数据。血栓形成和出血事件以及血液学演变在数据库中被归类为主要事件。在OBENE注册库的760例MPN患者中，25例（3.3%）接受了DOAC治疗。中位随访时间为2.1年（0.12 - 4.3年）。开具DOACs的原因分别是13例患者为心房颤动，12例患者为血栓形成事件。我们仅观察到1例血栓形成事件（4%）和3例严重出血事件（12%）。一项病例对照研究未发现接受LDA和DOACs治疗的患者在血栓形成或出血事件方面存在显著差异。这些初步结果表明，DOACs在MPN患者中使用可能高效且安全。
