Section of Hematology, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA,
Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
Acta Haematol. 2023;146(4):287-292. doi: 10.1159/000530153. Epub 2023 Apr 26.
Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) often receive antibacterial prophylaxis. Antibacterial agents can cause elevations in the prothrombin time and international normalized ratio (INR). The impact of prophylactic antibacterials on the coagulation profiles and bleeding risk in patients with AML/MDS is unknown. We evaluated patients with AML or MDS who were being admitted to the hospital. The cohort was divided into two groups of patients: (1) those receiving and (2) those not receiving prophylactic antibacterials, at the time of admission. We conducted a retrospective cohort study of adult patients with AML/MDS admitted to Yale-New Haven Hospital between 2015-2019. The study was approved by the Yale Institutional Review Board. Inclusion criteria included patients >18 years old with a diagnosis of AML or MDS admitted to the hospital. We identified 150 individual patient encounters with active AML/MDS admitted to Yale-New Haven of which 32 occurred while on and 118 while off antibacterial prophylaxis. Median duration of pre-admission antibacterial exposure was 2 (range: 0.07-24) months. Patients on antibacterial prophylaxis had higher INR (median 1.14 vs. 1.03, p = 0.0002), and higher partial thromboplastin time prolongation (median 26.5 vs. 24.3, p < 0.0014), than patients without antibacterial prophylaxis. Patients without antibacterial prophylaxis had higher rates of bleeding using the ISTH-defined criteria (24.6% vs. 6.3%, p = 0.043), including higher rates of ISTH major (2 vs. 0) and clinically relevant bleeding (9 vs. 0). Patients with AML/MDS on antibacterial prophylaxis were more likely to have an abnormal coagulation profile when compared with their counterparts not on prophylaxis. Conversely, rates of bleeding were higher in patients not on prophylaxis. These data suggest that prophylactic antibacterials do not increase bleeding risk in patients with AML/MDS.
患有急性髓系白血病 (AML) 和骨髓增生异常综合征 (MDS) 的患者通常会接受抗菌预防。抗菌药物会导致凝血酶原时间和国际标准化比值 (INR) 升高。预防性抗菌药物对 AML/MDS 患者的凝血谱和出血风险的影响尚不清楚。我们评估了因 AML 或 MDS 而入院的患者。该队列分为两组患者：（1）入院时接受预防性抗菌药物治疗的患者，（2）入院时未接受预防性抗菌药物治疗的患者。我们对 2015 年至 2019 年期间入住耶鲁纽黑文医院的 AML/MDS 成年患者进行了回顾性队列研究。该研究得到了耶鲁机构审查委员会的批准。纳入标准包括年龄大于 18 岁、诊断为 AML 或 MDS 并入院的患者。我们共确定了 150 例 AML/MDS 患者的个体就诊情况，其中 32 例患者在接受抗菌药物预防治疗时入院，118 例患者在停止抗菌药物预防治疗时入院。入院前抗菌药物暴露的中位持续时间为 2 个月（范围：0.07-24 个月）。接受抗菌药物预防治疗的患者 INR 更高（中位数 1.14 比 1.03，p = 0.0002），部分凝血活酶时间延长更明显（中位数 26.5 比 24.3，p < 0.0014），与未接受抗菌药物预防治疗的患者相比。根据 ISTH 定义的标准，未接受抗菌药物预防治疗的患者出血率更高（24.6%比 6.3%，p = 0.043），包括 ISTH 主要出血（2 例比 0 例）和临床相关出血（9 例比 0 例）。与未接受预防治疗的患者相比，接受抗菌药物预防治疗的 AML/MDS 患者更有可能出现凝血异常。相反，未接受预防治疗的患者出血率更高。这些数据表明，预防性抗菌药物不会增加 AML/MDS 患者的出血风险。
