Mahé Kristell, Delluc Aurélien, Chauveau Aurélie, Castellant Philippe, Mottier Dominique, Dalbies Florence, Berthou Christian, Guillerm Gaëlle, Lippert Eric, Ianotto Jean-Christophe
Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, Hôpital Morvan, CHRU de Brest, Avenue Foch, 29609, Brest Cedex, France.
EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
Ann Hematol. 2018 Jan;97(1):101-107. doi: 10.1007/s00277-017-3164-x. Epub 2017 Nov 21.
Atrial arrhythmias (AA) induce a high rate of thromboses and require vitamin K antagonists (VKA) or direct anticoagulants (DOAC) prescriptions. Essential thrombocythemia (ET) and polycythemia vera (PV) are also pro-thrombotic diseases. The prevention of thromboses is based on the association of cytoreductive drug and low-dose aspirin (LDA). We studied the incidence and complications of AA among patients with ET or PV. We identified 96/713 patients (13.5%) carrying AA. These patients were older (median 72.1 vs. 61.3 years old, p < 0.0001). In a case-control analysis, we observed that patients with AA had a higher frequency of cardiovascular risk factors (77/96, 80% vs. 61/96, 61%; p = 0.01). A higher incidence of thromboses before and after myeloproliferative neoplasm (MPN) diagnosis was seen in this group: 26/96, 27.1% vs. 14/96, 14.6% (p = 0.03) and 34/96, 35% vs. 18/96, 18.8% (p = 0.009). Most of the events were arterial (82 vs. 61%, p = 0.09). This translates into a shorter thrombosis-free survival (11.0 vs. 21.6 years, p = 0.01). Continuation of LDA in this situation exposed patients to more thrombotic events (p = 0.04) but VKA did not seem to be good anticoagulant drugs either. The association of AA and MPN is more frequent than expected. AA clearly increased the thrombotic risk of these patients. Anticoagulant drugs should be carefully managed between cardiologists and hematologists. Association of LDA and VKA or the role of DOAC in such population should be rapidly discussed to reduce the thrombotic rate.
房性心律失常（AA）会导致高血栓形成率，需要使用维生素K拮抗剂（VKA）或直接抗凝剂（DOAC）进行治疗。原发性血小板增多症（ET）和真性红细胞增多症（PV）也是血栓形成前状态的疾病。血栓形成的预防基于细胞减灭药物与小剂量阿司匹林（LDA）的联合使用。我们研究了ET或PV患者中AA的发病率及并发症。我们确定了96/713例（13.5%）患有AA的患者。这些患者年龄更大（中位年龄72.1岁对61.3岁，p<0.0001）。在病例对照分析中，我们观察到患有AA的患者心血管危险因素的发生率更高（77/96，80%对61/96，61%；p=0.01）。在这组患者中，骨髓增殖性肿瘤（MPN）诊断前后血栓形成的发生率更高：26/96，27.1%对14/96，14.6%（p=0.03）以及34/96，35%对18/96，18.8%（p=0.009）。大多数事件为动脉性（82%对61%，p=0.09）。这意味着无血栓生存期更短（11.0年对21.6年，p=0.01）。在这种情况下继续使用LDA会使患者面临更多血栓形成事件（p=0.04），但VKA似乎也不是很好的抗凝药物。AA与MPN的关联比预期更常见。AA明显增加了这些患者的血栓形成风险。抗凝药物在心脏病专家和血液科医生之间应谨慎管理。应迅速讨论LDA与VKA的联合使用或DOAC在此类人群中的作用，以降低血栓形成率。
