Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients
Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients
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DOI：
10.3324/haematol.2012.069559
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发表时间：
2013-03-01
期刊：
影响因子：
10.1
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;Lopez-Anglada, Lucia;Ramon Gonzalez-Porras, Jose
异基因造血干细胞移植受者发生出血性和血栓性并发症的风险增加。然而，这些复杂患者中两种危及生命的并发症的竞争风险仍未得到很好的定义。我们回顾性分析了431例同种异体移植受者的数据，以确定血栓形成和出血的发生率、危险因素和死亡率。显著的临床出血比症状性血栓形成更常见。14年时出血事件的累积发生率为30.2%。14年时静脉或动脉血栓形成的累积发生率分别为11.8%和4.1%。对静脉血栓形成竞争因素的分析显示，广泛的慢性移植物抗宿主病是唯一的独立预后危险因素。相比之下，6个因素与出血风险增加相关：晚期疾病、消融预处理方案、脐带血移植、抗凝、急性移植物抗宿主病和移植相关微血管病。血栓形成对总生存率无显著影响（P=0.856）。然而，严重的临床出血与较差的生存率相关（P
Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P