Ionescu Filip, Anusim Nwabundo, Zimmer Markie, Jaiyesimi Ishmael
Department of Internal Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, Michigan, USA.
H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida, USA.
Eur J Haematol. 2022 Sep;109(3):282-288. doi: 10.1111/ejh.13807. Epub 2022 Jun 8.
Sickle trait (Hb SA) or sickle disease (Hb SS) carries increased risk of venous thromboembolism (VTE). Hb SS patients are young and lack common comorbid conditions that qualify them for VTE prophylaxis (VTEP).
Retrospective, multicenter analysis of Hb SS/Hb SA adult patients between January 2013 and December 2018.
There were 803 Hb SA (525 patients) and 1020 Hb SS admissions (262 patients). VTEP use was similar between Hb SA and controls (42% vs. 46%; p-value = .06) and Hb SS and controls (45% vs. 42%; p-value = .13). Hb SS/Hb SA patients more frequently received more than half of prescribed doses of VTEP. In multivariate analysis, increasing age and longer hospitalizations were positive predictors. Odds of VTEP use varied with treatment site for Hb SS patients, whereas comorbid conditions, admission hemoglobin and platelet count were not predictive. By contrast, in Hb SA patients, comorbid conditions, higher admission hemoglobin, and higher admission platelet counts raised the odds of VTEP being offered.
VTEP is underused in Hb SS/Hb SA patients. There may be a trend toward offering more VTEP in Hb SS disease, but not in Hb SA patients, where VTEP prescribing is driven by comorbid conditions rather than genotype. Patient compliance does not appear to play a major role, but intercenter variability suggests provider education may improve VTEP use.
镰状细胞性状（Hb SA）或镰状细胞病（Hb SS）会增加静脉血栓栓塞（VTE）的风险。Hb SS患者较为年轻，缺乏符合VTE预防（VTEP）条件的常见合并症。
对2013年1月至2018年12月期间的Hb SS/Hb SA成年患者进行回顾性多中心分析。
有803例Hb SA（525例患者）和1020例Hb SS入院病例（262例患者）。Hb SA患者与对照组之间VTEP的使用情况相似（42%对46%；p值 = 0.06），Hb SS患者与对照组之间也是如此（45%对42%；p值 = 0.13）。Hb SS/Hb SA患者更频繁地接受了超过规定剂量一半的VTEP。在多变量分析中，年龄增长和住院时间延长是积极的预测因素。Hb SS患者使用VTEP的几率因治疗地点而异，而合并症、入院时血红蛋白和血小板计数并无预测作用。相比之下，在Hb SA患者中，合并症、较高的入院血红蛋白和较高的入院血小板计数增加了提供VTEP的几率。
Hb SS/Hb SA患者中VTEP的使用不足。在Hb SS疾病中可能存在提供更多VTEP的趋势，但在Hb SA患者中并非如此，在Hb SA患者中VTEP的处方是由合并症而非基因型驱动的。患者依从性似乎不起主要作用，但中心间差异表明，对医疗服务提供者的教育可能会改善VTEP的使用。
