Cordella Stefano, Coluccio Valeria, Cuoghi Costantini Riccardo, D'Amico Roberto, Luppi Mario, Marietta Marco
Hematology Unit, Azienda Ospedaliero-Universitaria, 41124, Modena, Italy.
Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, 41124, Modena, Italy.
Ann Hematol. 2025 May 6. doi: 10.1007/s00277-025-06397-9.
Although patients with hematological malignancies carry a non-negligible risk of venous thromboembolic events (VTE), no risk assessment models (RAMs) have been developed and validated to predict this risk during their hospital stay. Moreover, the performance of RAMs developed to predict the thromboembolic and hemorrhagic risk in hospitalized medical patients has never been assessed in this specific population. In this observational study we sought to assess the incidence of VTE and hemorrhagic events (HE), to evaluate pharmacological prophylaxis use, and to test existing RAMs for TE and HE (Padua Predictions Score, PPS, and Improve Bleeding Score, IBS, respectively) in a population of 514 hematological patients at their first hospital admission. 165 patients were found to be at high thromboembolic and 114 at high hemorrhagic risk according to PPS and IBS; a total of 148 patients received pharmacological prophylaxis with low-molecular weight heparin (LMWH). An incidence of VTE (3.11%) and HE (1.75%) was found, with most thrombotic (15/16) and hemorrhagic (8/9) events occurring in patients not receiving prophylaxis. At the univariate analysis, the diagnosis of acute leukemia was significantly associated with an increased risk of VTE, whereas prophylaxis was found to be protective. However, at the multivariate analysis the statistical significance was lost for both of these variables (HR = 2.76, p = 0.218 and HR = 0.22, p = 0.170, respectively). PPS poorly performed in this population, but no other factors associated with VTE were found. Larger, multicenter studies to develop better RAMs tailored to HM patients are needed to improve VTE management in this population.
尽管血液系统恶性肿瘤患者发生静脉血栓栓塞事件（VTE）的风险不可忽视，但尚未开发并验证用于预测其住院期间该风险的风险评估模型（RAMs）。此外，为预测住院内科患者血栓栓塞和出血风险而开发的RAMs在这一特定人群中的性能从未得到评估。在这项观察性研究中，我们试图评估514例首次入院的血液系统患者中VTE和出血事件（HE）的发生率，评估药物预防的使用情况，并测试现有的TE和HE风险评估模型（分别为帕多瓦预测评分（PPS）和改进出血评分（IBS））。根据PPS和IBS，发现165例患者血栓栓塞风险高，114例患者出血风险高；共有148例患者接受了低分子量肝素（LMWH）药物预防。发现VTE发生率为3.11%，HE发生率为1.75%，大多数血栓形成事件（15/16）和出血事件（8/9）发生在未接受预防的患者中。单因素分析显示，急性白血病的诊断与VTE风险增加显著相关，而预防措施具有保护作用。然而，在多因素分析中，这两个变量的统计学意义均消失（HR分别为2.76，p = 0.218和HR为0.22，p = 0.170）。PPS在该人群中表现不佳，但未发现与VTE相关的其他因素。需要开展更大规模的多中心研究，以开发更适合血液系统恶性肿瘤患者的风险评估模型，从而改善该人群的VTE管理。
