Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Thrombosis Expert Center, Maastricht University Medical Center, Maastricht, The Netherlands.
J Thromb Thrombolysis. 2021 Aug;52(2):590-596. doi: 10.1007/s11239-021-02393-8. Epub 2021 Feb 1.
Managing anticoagulation in hematological malignancy patients with atrial fibrillation and thrombocytopenia is a clinical challenge with limited data. We aimed to identify anticoagulation management strategies and evaluate bleeding and thrombosis rates associated with each approach. A retrospective cohort study in Israel and the Netherlands was conducted. Patients with hematological malignancy and atrial fibrillation were indexed when platelets were < 50 × 10/L and followed for 30 days. The cohort included 61 patients of whom 42 (69%) had anticoagulation held at index. On multivariate analysis, holding anticoagulation was associated with age < 65 years and atrial fibrillation diagnosed within 30 days prior index. Clinically relevant bleeding was diagnosed in 7 (16.7%) and 1 (5.3%) of patients who had anticoagulation held and continued respectively, while arterial thromboembolism occurred in 1 patient in each group (2.4% and 5.3%, respectively). All-cause mortality rate was high at 45%. Accordingly, the 30-day bleeding risk may outweigh the risk of arterial thromboembolism in hematological malignancy, platelets < 50 × 10/L and atrial fibrillation.
在伴发心房颤动和血小板减少症的血液恶性肿瘤患者中管理抗凝治疗是一个临床挑战，相关数据有限。我们旨在确定抗凝治疗管理策略，并评估每种方法相关的出血和血栓形成发生率。在以色列和荷兰进行了一项回顾性队列研究。当血小板<50×10/L 时对伴发心房颤动的血液恶性肿瘤患者进行索引，并在 30 天内进行随访。该队列包括 61 名患者，其中 42 名（69%）在索引时停用抗凝药物。多变量分析显示，停用抗凝药物与年龄<65 岁和索引前 30 天内诊断出的心房颤动相关。分别有 7 名（16.7%）和 1 名（5.3%）停用和继续抗凝治疗的患者被诊断为临床相关出血，而每组各有 1 例患者发生动脉血栓栓塞（2.4%和 5.3%）。全因死亡率高达 45%。因此，在血小板<50×10/L 和伴发心房颤动的血液恶性肿瘤患者中，30 天出血风险可能超过动脉血栓栓塞风险。
