Department of Hematology, 12636Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221080166. doi: 10.1177/10760296221080166.
Acute promyelocytic leukemia (APL) usually presents with a series of coagulation-anticoagulation disturbance. Early administration of All-trans retinoic acid (ATRA) can reduce the risk of bleeding, but the potential for thrombosis needs to be addressed in some cases. The role of arsenic agent in correcting coagulation disorder remains to be studied, but oral arsenic agent shows potential advantages in coagulation recovery compared with intravenous agent, and chemotherapy can aggravate the progress of coagulation disease. In addition to early application of ATRA, avoiding invasive procedures and transfusion support can reduce the risk of bleeding. Whether the administration of heparin, thrombomodulin, recombinant factor VIIa or antifibrinolytics reduces the risk of bleeding and thrombosis associated with APL remains to be further explored, and their routine use outside of clinical trials is not recommended. This article reviews the effects of related drugs on coagulation-anticoagulation balance in APL patients.
急性早幼粒细胞白血病（APL）通常会出现一系列凝血-抗凝紊乱。早期应用全反式维甲酸（ATRA）可以降低出血风险，但在某些情况下需要解决血栓形成的风险。砷剂在纠正凝血障碍中的作用仍有待研究，但口服砷剂在凝血恢复方面显示出比静脉用砷剂有潜在优势，且化疗会加重凝血疾病的进展。除了早期应用 ATRA 外，避免有创操作和输血支持可以降低出血风险。肝素、血栓调节蛋白、重组 VIIa 因子或抗纤维蛋白溶解剂的应用是否可以降低与 APL 相关的出血和血栓形成风险仍有待进一步探讨，不建议在临床试验之外常规使用。本文综述了相关药物对 APL 患者凝血-抗凝平衡的影响。
