在伊布替尼相关性心房颤动患者中抗凝的风险与获益分析。
The risk vs. benefit calculus of anticoagulation in patients with ibrutinib-related atrial fibrillation.
机构信息
Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
出版信息
Leuk Lymphoma. 2024 Feb;65(2):168-174. doi: 10.1080/10428194.2023.2278433. Epub 2024 Jan 24.
For ibrutinib-related atrial fibrillation (IRAF), guidelines for anticoagulation do not exist. We sought to describe stroke, bleeding, and anticoagulation rates among patients with IRAF. We performed a single-center retrospective review of 168 patients treated with ibrutinib followed from 2013 to 2022. Over a median follow-up of 6.4 years, 44 (26.0%) patients developed IRAF of which 38 (86.4%) had a CHA2DS2-VASc ≥2 and 7 (15.9%) had a HAS-BLED ≥3. Anticoagulation was initiated in 20 (45.5%) without a clear pattern in scores, risk factors, or cumulative dose, besides having another reason for anticoagulation. Few patients with IRAF developed non-hemorrhagic CVA ( = 3, 6.8%) or significant bleeding ( = 3, 6.8%). Among those with each adverse outcome, 2 in each group were anticoagulated and all were older than 65 years old. In conclusion, decisions for anticoagulation vary widely and patients who are elderly or with HTN may be most at risk for CVA or significant bleed.
对于伊布替尼相关的心房颤动（IRAF），抗凝治疗指南并不存在。我们旨在描述 IRAF 患者的卒中、出血和抗凝治疗发生率。我们对 2013 年至 2022 年间接受伊布替尼治疗的 168 例患者进行了单中心回顾性研究。在中位数为 6.4 年的随访中，44 例（26.0%）患者发生了 IRAF，其中 38 例（86.4%）CHA2DS2-VASc≥2，7 例（15.9%）HAS-BLED≥3。尽管有其他抗凝治疗的原因，但在评分、危险因素或累积剂量方面，无明确模式的情况下，仅 20 例（45.5%）患者开始抗凝治疗。少数 IRAF 患者发生非出血性 CVA（ = 3，6.8%）或显著出血（ = 3，6.8%）。在每个不良结局的患者中，每组有 2 人接受了抗凝治疗，所有患者年龄均大于 65 岁。总之，抗凝治疗的决策差异很大，年龄较大或患有高血压的患者可能面临更高的卒中或显著出血风险。
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