Risk factors for venous thromboembolism in adults with hemoglobin SC or Sβ+ thalassemia genotypes
Risk factors for venous thromboembolism in adults with hemoglobin SC or Sβ+ thalassemia genotypes
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DOI：
10.1016/j.thromres.2016.03.003
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发表时间：
2016-05-01
影响因子：
7.5
通讯作者：
Naik, Rakhi P.
中科院分区：
文献类型：
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作者：
Yu, Tiffany T.;Nelson, Julie;Naik, Rakhi P.
简介：静脉血栓栓塞 (VTE) 在镰状细胞病 (SCD) 中很常见；然而，与镰状变异综合征患者发生 VTE 相关的危险因素尚不清楚。本研究的主要目的是确定血红蛋白 SC 或 S β(+) 地中海贫血基因型成人 VTE 的血液学和临床危险因素。 材料和方法：我们对 2008 年至 2012 年在成人镰状细胞中心随访的血红蛋白 SC 和 S β(+) 地中海贫血基因型患者进行了回顾性横断面分析。通过电子记录审查收集 SCD 特异性合并症。结果：共有 116 名患者进行分析，其中 85 名患者 (73%) 患有血红蛋白 SC 疾病，31 名患者 (27%) 患有 S β(+) 地中海贫血。三十二名 (28%) 患者有经证实的非导管相关 VTE 病史。与没有 VTE 病史的个体相比，有 VTE 病史的个体的平均基线血红蛋白水平较高（11.7 g/dL vs. 11.0 g/dL，p = 0.003）。此外，与未发生 VTE 的患者相比，手术脾切除术的发生率更高（25.0% vs. 4.8%，p = 0.001）。在多变量分析中，基线血红蛋白升高（比值比 [OR] 2.45（95% 置信区间 [CI] 1.42-4.23））和脾切除手术史（OR 5.76 [CI 1.43-23.22]）与 VTE 风险独立相关。 结论：较高的基线血红蛋白是血红蛋白 SC 或 S 患者发生非导管相关 VTE 的危险因素β(+) 地中海贫血基因型。手术脾切除术是其他血红蛋白病（例如中间型β地中海贫血）中 VTE 的已知危险因素，也与镰状变异综合征中的 VTE 相关。未来的研究需要验证这些发现，并调查在血红蛋白 SC 和 S β(+) 地中海贫血患者中观察到的高凝状态机制。 (C) 2016 Elsevier Ltd. 保留所有权利。
Introduction: Venous thromboembolism (VTE) is common in sickle cell disease (SCD); however, the risk factors associated with VTE in patients with sickle variant syndromes are not known. The primary aim of this study was to determine hematologic and clinical risk factors for VTE in adults with hemoglobin SC or S beta(+) thalassemia genotypes.Materials and methods: We conducted a retrospective cross-sectional analysis of patients with hemoglobin SC and S beta(+) thalassemia genotypes followed at the Sickle Cell Center for Adults from 2008 to 2012. Data on baseline hematologic parameters and SCD-specific comorbidities were collected from review of electronic records.Results: A total of 116 patients, 85 (73%) with hemoglobin SC disease and 31 (27%) with S beta(+)-thalassemia, were included for analysis. Thirty-two (28%) patients had a verified history of non-catheter related VTE. Mean baseline hemoglobin levels were higher among individuals with a history of VTE compared to those without (11.7 g/dL vs. 11.0 g/dL, p = 0.003). In addition, the prevalence of surgical splenectomy was higher among patients with VTE compared to those without (25.0% vs. 4.8%, p = 0.001). On multivariate analysis, elevated baseline hemoglobin (odds ratio [OR] 2.45 (95% confidence interval [CI] 1.42-4.23)) and history of surgical splenectomy (OR 5.76 [CI 1.43-23.22]) were independently associated with VTE risk.Conclusions: Higher baseline hemoglobin is a risk factor for non-catheter-related VTE in patients with hemoglobin SC or S beta(+) thalassemia genotypes. Surgical splenectomy, which is a known risk factor for VTE in other hemo-globinopathies such as beta-thalassemia intermedia, is also associated with VTE in sickle variant syndromes. Future studies are needed to validate these findings and to investigate the mechanisms of hypercoagulability observed in patients with hemoglobin SC and S beta(+) thalassemia. (C) 2016 Elsevier Ltd. All rights reserved.