Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Florence, Italy.
Am J Hematol. 2024 Oct;99(10):1862-1869. doi: 10.1002/ajh.27416. Epub 2024 Jun 12.
Two-hundred pregnancies involving 100 women with essential thrombocythemia (ET) were accessed from Mayo Clinic databases (1990-2023). Median platelet count displayed a decline during pregnancy, nadiring at 48% of baseline, in the third trimester: 704-369 × 10/L. Live birth rate was 72%. Of 53 (27%) unintentional pregnancy losses, 48 (24%) occurred in the first trimester. Other fetal complications included preterm birth 3%, intrauterine growth retardation 3%, and stillbirth 1%. Maternal complications included major hemorrhage (7%), preeclampsia (6%), thrombosis (1%), and placental abruption (0.5%). Antepartum management included no specific therapy in 52 (26%), aspirin alone in 112 (56%), aspirin combined with cytoreductive drugs or systemic anticoagulants in 23 (12%), and other permutations in the remaining. Postpartum systemic anticoagulation was documented in 29 (15%) pregnancies. Unintentional first-trimester loss was predicted by prior fetal loss (43% vs. 18%; p < .01), diabetes mellitus (DM; 67% vs. 23%; p = .02), and absence of aspirin therapy (45% vs. 14%; p < .01); the salutary effect of aspirin therapy was independent of the other two risk factors and apparent in both high (presence of ≥1 risk factor; 33% vs. 61%; p = .07) and low (absence of both risk factors; 10% vs. 34%; p < .01) risk scenarios. The benefit of aspirin therapy, in preventing first-trimester loss, was significant in both JAK2-mutated (18% vs. 50%; p < .01) and CALR-mutated (8% vs. 43%; p < .01) cases. Aspirin use was also associated with a lower risk of venous thrombosis (0% vs. 3%; p = .03). By contrast, the use of systemic anticoagulation, antepartum or postpartum, did not influence fetal or maternal complication rates. CALR mutation and DM predicted maternal hemorrhage (13% vs. 4%; p = .05) and preeclampsia (33% vs. 5%; p = .03), respectively. The current study demonstrates the protective role of aspirin in preventing first-trimester loss in ET, independent of driver mutation status or other risk factors.
两百例涉及 100 名原发性血小板增多症（ET）女性的妊娠案例从梅奥诊所数据库中获取（1990-2023 年）。妊娠期间血小板计数中位数下降，在孕晚期达基线的 48%：704-369×10/L。活产率为 72%。53 例（27%）非意愿性妊娠丢失中，48 例（24%）发生在孕早期。其他胎儿并发症包括早产 3%、宫内生长受限 3%和死胎 1%。母体并发症包括大出血（7%）、子痫前期（6%）、血栓形成（1%）和胎盘早剥（0.5%）。产前管理包括 52 例（26%）无特定治疗、112 例（56%）单用阿司匹林、23 例（12%）阿司匹林联合细胞减少药物或全身抗凝剂，其余病例采用其他组合。29 例（15%）妊娠产后接受全身抗凝治疗。首次妊娠早期流产的预测因素包括既往胎儿丢失（43%比 18%；p<0.01）、糖尿病（DM；67%比 23%；p=0.02）和无阿司匹林治疗（45%比 14%；p<0.01）；阿司匹林治疗的有益作用独立于其他两个危险因素，在高（存在≥1个危险因素；33%比 61%；p=0.07）和低（无两个危险因素；10%比 34%；p<0.01）风险情况下均有表现。在 JAK2 突变（18%比 50%；p<0.01）和 CALR 突变（8%比 43%；p<0.01）病例中，阿司匹林治疗预防首次妊娠早期流产的效果显著。阿司匹林治疗还与静脉血栓形成风险降低相关（0%比 3%；p=0.03）。相比之下，产前或产后使用全身抗凝剂并不影响胎儿或母体并发症发生率。CALR 突变和 DM 分别预测母体出血（13%比 4%；p=0.05）和子痫前期（33%比 5%；p=0.03）。本研究表明，阿司匹林在预防 ET 妊娠早期流产中具有保护作用，独立于驱动突变状态或其他危险因素。
