Risk for Arterial and Venous Thrombosis in Patients With Myeloproliferative Neoplasms: A Population-Based Cohort Study.
Risk for Arterial and Venous Thrombosis in Patients With Myeloproliferative Neoplasms: A Population-Based Cohort Study.
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DOI：
10.7326/m17-0028
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发表时间：
2018-03-06
影响因子：
39.2
通讯作者：
Andersson TML
中科院分区：
文献类型：
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作者：
Hultcrantz M;Björkholm M;Dickman PW;Landgren O;Derolf ÅR;Kristinsson SY;Andersson TML
据报道，骨髓增生性肿瘤（MPN）患者发生血栓事件的风险增加，然而，与匹配的对照组相比，没有基于人群的研究估计了过量的血栓风险。评估MPN患者与对照组相比动脉和静脉血栓形成的风险。配对队列研究。1987-2009年瑞典基于人口的环境，随访至2010年。9429名MPN患者和35820名匹配的人群对照。主要观察指标为动脉和静脉血栓形成率。采用灵活参数模型计算风险比（hr）和累积发病率，95%置信区间（ci）。与对照组相比，MPN患者在3个月、1年和5年时动脉血栓形成的hr分别为3.0 （95% CI， 2.7至3.4）、2.0 （CI， 1.8至2.2）和1.5 （CI， 1.4至1.6）。静脉血栓形成的相应hr分别为9.7 （CI, 7.8 ~ 12.0）、4.7 （CI, 4.0 ~ 5.4）和3.2 （CI, 2.9 ~ 3.6）。所有年龄组的发病率均显著升高，MPN亚型之间的发病率相似。MPN患者5年累计血栓发生率呈快速上升趋势，随访期间呈平缓上升趋势。静脉血栓形成的HR在最近的日历期间下降。没有关于个人实验室结果或治疗的信息。与匹配的人群对照相比，所有年龄组的MPN患者的动脉和静脉血栓形成率都显著增加，在诊断时和诊断后不久，血栓形成率最高。随着时间的推移，静脉血栓形成率的降低很可能反映了临床管理的进步。
Patients with myeloproliferative neoplasms (MPN) are reported to be at increased risk for thrombotic events, however, no population-based study has estimated the excess thrombotic risk compared to matched controls. To assess the risk of arterial and venous thrombosis in MPN patients compared to matched controls. Matched cohort study. Population-based setting in Sweden 1987–2009 with follow-up to 2010. 9,429 MPN patients and 35,820 matched population controls. Primary outcome was rate of arterial and venous thrombosis. Flexible parametric models were used to calculate hazard ratios (HRs) and cumulative incidence with 95% confidence intervals (CIs). The HRs of arterial thrombosis among MPN patients compared to controls at 3 months, 1- and 5 years were 3.0 (95% CI, 2.7 to 3.4), 2.0 (CI, 1.8 to 2.2), and 1.5 (CI, 1.4 to 1.6), respectively. The corresponding HRs for venous thrombosis were 9.7 (CI, 7.8 to 12.0), 4.7 (CI, 4.0 to 5.4), and 3.2 (CI, 2.9 to 3.6). The rate was significantly elevated across all age groups and was similar between MPN subtypes. The 5-year cumulative incidence of thrombosis in MPN patients showed an initial rapid increase followed by more leveled increases during follow up. The HR of venous thrombosis decreased during more recent calendar periods. No information on individual laboratory results or treatment. Patients with MPN across all age groups are at a significantly increased rate of arterial and venous thrombosis compared to matched population controls, with rates highest at and shortly following diagnosis. Decreases in the rate of venous thrombosis over time most likely reflects advances in clinical management.