Management patterns and outcomes in symptomatic venous thromboembolism following allogeneic hematopoietic stem cell transplantation. A 15-years experience at a single center
Management patterns and outcomes in symptomatic venous thromboembolism following allogeneic hematopoietic stem cell transplantation. A 15-years experience at a single center
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DOI：
10.1016/j.thromres.2016.02.016
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发表时间：
2016-06-01
影响因子：
7.5
通讯作者：
Ramon Gonzalez-Porras, Jose
中科院分区：
文献类型：
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作者：
Labrador, Jorge;Gonzalez-Rivero, Joaquin;Ramon Gonzalez-Porras, Jose
背景资料：经验是有限的静脉血栓栓塞症（VTE）患者的抗血栓治疗后，异基因造血干细胞transplantation（HSCT）.Design and methods：我们描述了一个队列的患者出现症状性VTE后，异基因造血干细胞transplantation，包括管理模式和outcomes.Results：24例患者发生了深静脉血栓形成和/或肺栓塞无关的导管。中位VTE诊断时间和抗血栓治疗时间分别为9.5和6个月。11例患者接受全剂量低分子量肝素（LMWH）治疗。11例轻微出血、血小板减少或肾衰竭患者接受预防性剂量LMWH。在2例患者中，由于血小板减少症和出血插入下腔静脉滤器。发生了2起严重出血事件和4起危及生命的出血事件，因此永久停用LMWH。2例死亡直接归因于出血。10例患者发生导管相关性VTE。中位诊断时间和抗凝持续时间分别为2.5个月和3个月。所有患者均拔除导管。4例患者给予治疗剂量的LMWH，其中2例因出血而减少。6例患者给予低分子量肝素，1例患者因肾衰竭而减量。有三次轻微出血。血栓复发率为29.4%（n = 10）。复发患者未接受抗血栓治疗（n = 4）、中等剂量LMWH（n = 2）、低剂量LMWH（n = 2）或醋硝香豆素（n = 2）。8例复发性VTE患者有广泛的慢性移植物抗宿主病（GVHD）。结论：低分子肝素用于大多数HSCT受者，但他们中的一半可能不会接受全剂量的低分子肝素。血小板减少、肾损害和出血是降低LMWH的原因。此外，临床相关出血或复发性VTE的发生率也非常显著。GVHD的发生是主要原因。(C)2016爱思唯尔有限公司版权所有。
Background: Experience is limited with regard to antithrombotic therapy in patients with venous thromboembolism (VTE) following allogeneic hematopoietic stem cell transplantation (HSCT).Design and methods: We described a cohort of patients presenting with symptomatic VTE following allogeneic HSCT, including management patterns and outcomes.Results: Twenty-four patients developed a deep vein thrombosis and/or pulmonary embolism unrelated to a catheter. Median time of VTE diagnosis and duration of antithrombotic therapy were 9.5 and 6 months. Eleven patients were treated with full-dose low molecular weight heparin (LMWH). Eleven patients with minor bleeding, thrombocytopenia or renal failure received prophylactic dose LMWH. In two patients an inferior vena cava filter was inserted due to thrombocytopenia and bleeding. There were 2 major and 4 life-threatening bleeding episodes, so LMWH was discontinued permanently. Two deaths were directly attributable to bleeding. Ten patients developed a catheter-associated VTE. Median time to diagnosis and duration of anticoagulation was 2.5 and 3 months. Catheter was removed in all patients. LMWH was administered at therapeutic-dose in 4 patients, and was reduced by bleeding in 2 of them. LMWH was administered at prophylactic-dose in 6 patients, and was reduced by renal failure in one patient. There were three episodes of minor bleeding. Rate of clot recurrence was 29.4% (n = 10). Patients at recurrence were without antithrombotic treatment (n = 4), intermediate-dose LMWH(n = 2), low-dose LMWH (n = 2) or acenocumarol (n = 2). Eight patients with recurrence VTE had extensive chronic graft versus host disease (GVHD).Conclusions: LMWH was used in most HSCT recipients but half of them may not receive full-dose LMWH. Thrombocytopenia, renal impairment and bleeding were the reasons for reducing LMWH. Also, rates of clinically relevant hemorrhage or recurrent VTE were highly significant. The development of GVHD could mainly explain these findings. (C) 2016 Elsevier Ltd. All rights reserved.