Sabljic Nikica, Mitrovic Mirjana, Pantic Nikola, Thachil Jecko
Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Hamostaseologie. 2024 Mar 11. doi: 10.1055/a-2238-4782.
Despite enormous improvement in the management of patients with acute promyelocytic leukemia (APL), the distinctive coagulopathy observed at presentation in affected patients is often life-threatening. While hemorrhagic manifestations are well known and described in this setting, APL-related thromboses are underappreciated. Data regarding this complication are scarce showing variable incidence. Furthermore, risk factors for thrombosis are inconsistent and unreliable; so, differentiation of increased risk of hemorrhage from an increased thrombotic risk is quite difficult in the absence of adequate predictive scores. Besides, prophylactic use of anticoagulants and recombinant thrombomodulin are a matter of ongoing debate. Also, due to the common feature of thrombocytopenia and other hemorrhagic risks, patients with APL are excluded from trials analyzing anticoagulant prophylaxis in cancers; so, data from prospective trials are lacking. A detailed analysis of thrombotic risks in APL with the development of a reliable risk stratification model is needed to further improve the care of APL patients.
尽管急性早幼粒细胞白血病（APL）患者的管理有了巨大改善，但在患病患者就诊时观察到的独特凝血病往往危及生命。虽然出血表现在此情况下广为人知并已有描述，但与APL相关的血栓形成却未得到充分认识。关于这一并发症的数据稀少，发病率各不相同。此外，血栓形成的危险因素并不一致且不可靠；因此，在缺乏足够预测评分的情况下，很难区分出血风险增加和血栓形成风险增加。此外，预防性使用抗凝剂和重组血栓调节蛋白仍存在争议。而且，由于血小板减少和其他出血风险的共同特征，APL患者被排除在分析癌症抗凝预防的试验之外；因此，缺乏前瞻性试验的数据。需要对APL中的血栓形成风险进行详细分析，并建立可靠的风险分层模型，以进一步改善APL患者的护理。
