Lecumberri Ramón, Ruiz-Artacho Pedro, Trujillo-Santos Javier, Marcos-Jubilar María, Pérez-Pinar Montserrat, Quéré Isabelle, Claver Gisela, Gorostidi Juan, Bikdeli Behnood, Monreal Manuel
Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain.
Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain.
Am J Hematol. 2025 Mar;100(3):375-382. doi: 10.1002/ajh.27579. Epub 2025 Jan 10.
Managing acute venous thromboembolism (VTE) in patients with thrombocytopenia is challenging. We used data from the RIETE registry to investigate the impact of baseline thrombocytopenia on early VTE-related outcomes, depending on the initial presentation as pulmonary embolism (PE) or isolated lower-limb deep vein thrombosis (DVT). From March 2003 to November 2022, 90 418 patients with VTE were included. Thrombocytopenia was categorized as severe (< 50 000/μL, n = 303) or moderate (50 000-99 999/μL, n = 1882). The primary outcome, fatal PE within 15 days after diagnosis, and secondary outcomes, including major bleeding and recurrent VTE, were analyzed using multivariable-adjusted models. Among 52 703 patients with PE, the 15-day case-fatality rates from PE were 5.8% for severe thrombocytopenia, 4.5% for moderate thrombocytopenia, and 1.1% for normal platelet counts. In 37 715 patients with isolated DVT, the cumulative incidence of fatal PE were 0, 0.2%, and 0.05%, respectively. Multivariable analysis revealed a five-fold increase in the risk for fatal PE in severe thrombocytopenia (adjusted HR: 4.89; 95%CI: 2.55-9.39) without significant differences between severe and moderate thrombocytopenia. Thrombocytopenia, either moderate or severe, was also associated with increased risk for both, major bleeding and recurrent VTE at 15 days. Initial presentation with PE substantially worsened prognosis compared to isolated DVT. In conclusion, in patients with acute VTE, thrombocytopenia at baseline was associated with increased risk of early death from PE, a finding that was driven by the subgroup whose initial presentation was PE.
管理血小板减少症患者的急性静脉血栓栓塞症（VTE）具有挑战性。我们使用RIETE注册中心的数据，根据初始表现为肺栓塞（PE）或孤立性下肢深静脉血栓形成（DVT），研究基线血小板减少症对早期VTE相关结局的影响。2003年3月至2022年11月，纳入了90418例VTE患者。血小板减少症分为重度（<50000/μL，n = 303）或中度（50000 - 99999/μL，n = 1882）。使用多变量调整模型分析主要结局（诊断后15天内的致命性PE）和次要结局（包括大出血和复发性VTE）。在52703例PE患者中，重度血小板减少症患者的PE 15天病死率为5.8%，中度血小板减少症患者为4.5%，血小板计数正常者为1.1%。在37715例孤立性DVT患者中，致命性PE的累积发生率分别为0、0.2%和0.05%。多变量分析显示，重度血小板减少症患者致命性PE的风险增加了五倍（调整后HR：4.89；95%CI：2.55 - 9.39），重度和中度血小板减少症之间无显著差异。中度或重度血小板减少症也与15天时大出血和复发性VTE的风险增加相关。与孤立性DVT相比，初始表现为PE的患者预后明显更差。总之，在急性VTE患者中，基线血小板减少症与PE早期死亡风险增加相关，这一发现是由初始表现为PE的亚组驱动的。
