Saliba Walid, Mishchenko Elena, Cohen Shai, Rennert Gad, Preis Meir
Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
J Thromb Haemost. 2020 Apr;18(4):916-925. doi: 10.1111/jth.14754. Epub 2020 Feb 27.
The risk of thromboembolism in myelofibrosis remains incompletely understood.
To examine the association between myelofibrosis and each of venous and arterial thromboembolism.
A cohort of 1 469 790 adults without a diagnosis of myelofibrosis was identified on 1 January 2007, from the electronic medical records of the largest health-care provider in Israel. Participants were followed until 31 December 2016 for the occurrence of myelofibrosis. Four randomly selected controls (without myelofibrosis) were matched to each case of myelofibrosis on age, sex, religious identification, and index date. The two groups were followed from the index date until 31 December 2017 for the occurrence of venous and arterial thromboembolism.
The study included 642 patients with myelofibrosis and 2568 matched controls. Myelofibrosis was independently associated with increased risk of venous thromboembolism but not with arterial thromboembolism. The propensity score adjusted hazard ratios (HRs) were 6.88 (95% confidence interval [CI], 2.02-23.45) for venous thromboembolism, and 0.94 (0.49-1.77) for arterial thromboembolism. Atypical sites of venous thromboembolism occurred almost exclusively in patients with myelofibrosis (four events of Budd Chiari versus none, and two mesenteric vein thrombosis events versus one) and were more likely to occur around the time of myelofibrosis diagnosis. No significant association was found between JAK2 inhibitor treatment (ruxolitinib) and the risk of venous HR 0.97 (0.30-3.12) or arterial thromboembolism 1.68 (0.78-3.62).
Myelofibrosis is associated with increased risk of venous thromboembolism but not of arterial thromboembolism. Atypical sites of venous thromboembolism are more frequent in myelofibrosis and are more likely to occur shortly after diagnosis.
骨髓纤维化中血栓栓塞的风险仍未完全明确。
研究骨髓纤维化与静脉和动脉血栓栓塞之间的关联。
2007年1月1日，从以色列最大的医疗服务提供商的电子病历中识别出一组1469790名未诊断出骨髓纤维化的成年人。对参与者进行随访，直至2016年12月31日，观察骨髓纤维化的发生情况。每例骨髓纤维化患者随机匹配4名对照（无骨髓纤维化），匹配因素包括年龄、性别、宗教身份和索引日期。从索引日期开始对两组进行随访，直至2017年12月31日，观察静脉和动脉血栓栓塞的发生情况。
该研究纳入了642例骨髓纤维化患者和2568例匹配对照。骨髓纤维化与静脉血栓栓塞风险增加独立相关，但与动脉血栓栓塞无关。倾向评分调整后的静脉血栓栓塞风险比（HR）为6.88（95%置信区间[CI]，2.02 - 23.45），动脉血栓栓塞风险比为0.94（0.49 - 1.77）。静脉血栓栓塞的非典型部位几乎仅发生在骨髓纤维化患者中（布加综合征4例，而对照组无；肠系膜静脉血栓形成2例，对照组1例），且更可能在骨髓纤维化诊断时左右发生。未发现JAK2抑制剂治疗（鲁索替尼）与静脉血栓栓塞风险（HR 0.97，0.30 - 3.12）或动脉血栓栓塞风险（1.68，0.78 - 3.62）之间存在显著关联。
骨髓纤维化与静脉血栓栓塞风险增加相关，但与动脉血栓栓塞无关。静脉血栓栓塞的非典型部位在骨髓纤维化中更常见，且更可能在诊断后不久发生。
