Batyrbekova Nurgul, Hultcrantz Malin, Ravn Landtblom Anna, Szulkin Robert, Dickman Paul W, Andersson Therese M-L, Syriopoulou Elisavet
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Br J Haematol. 2025 Jul;207(1):189-200. doi: 10.1111/bjh.20141. Epub 2025 Jun 2.
Thromboembolism is one of the major complications in myeloproliferative neoplasms (MPNs), especially in the initial years post-diagnosis and with increasing age. This nationwide matched cohort study used Swedish registers to assess whether attained age or time since diagnosis is more important for thrombosis risk. We identified 17 830 MPN patients diagnosed between 2001 and 2021, each matched with 10 population controls by sex, age and diagnosis year. Rates of first thrombosis post diagnosis and hazard ratios (HRs) were estimated using flexible parametric survival models over time since diagnosis and attained age. Thrombosis rates were significantly higher in MPN patients at all ages, especially in the first 2 years post-diagnosis, after which the rates remained higher than in age-matched controls. At 5 years, HR (95% confidence interval) for any thrombosis comparing patients to controls was 1.8 (1.7-1.9) at age 65, 1.6 (1.5-1.7) at age 70 and 1.5 (1.4-1.6) at age 75 and older. Attained age was more important than time since diagnosis, particularly in patients without prior thrombosis. Thrombosis rates were highest within the first 2 years post-diagnosis, then depended more on attained age than on time since diagnosis. These findings emphasize the importance of age and early management in MPN patients to optimize clinical care.
血栓栓塞是骨髓增殖性肿瘤（MPN）的主要并发症之一，尤其是在诊断后的最初几年以及随着年龄增长时。这项全国性匹配队列研究利用瑞典的登记数据来评估达到的年龄或自诊断以来的时间对血栓形成风险而言哪个更重要。我们确定了2001年至2021年期间诊断的17830例MPN患者，每例患者按性别、年龄和诊断年份与10名人群对照进行匹配。使用灵活的参数生存模型根据自诊断以来的时间和达到的年龄估计诊断后首次血栓形成的发生率和风险比（HR）。各年龄段的MPN患者血栓形成率均显著更高，尤其是在诊断后的前2年，此后该发生率仍高于年龄匹配的对照。在5年时，65岁患者与对照相比发生任何血栓形成的HR（95%置信区间）为1.8（1.7 - 1.9），70岁时为1.6（1.5 - 1.7），75岁及以上时为1.5（1.4 - 1.6）。达到的年龄比自诊断以来的时间更重要，尤其是在既往无血栓形成的患者中。血栓形成率在诊断后的前2年内最高，然后更多地取决于达到的年龄而非自诊断以来的时间。这些发现强调了年龄和早期管理在MPN患者优化临床护理中的重要性。
