The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention
The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention
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DOI：
10.1182/blood-2007-10-117051
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发表时间：
2008-08-01
期刊：
影响因子：
20.3
通讯作者：
Streiff, Michael B.
中科院分区：
文献类型：
--
作者：
Gerber, David E.;Segal, Jodi B.;Streiff, Michael B.
静脉血栓栓塞症(VTE)在血液系统恶性肿瘤患者中的诊断越来越多。然而，在接受造血干细胞移植(HSCT)的患者中发生VTE的风险尚不清楚。我们调查了1514例接受HSCT的住院患者的VTE和出血的发生率和危险因素。未采用程序化的静脉血栓栓塞术。到HSCT第180天时，70名患者发生了75例症状性VTE(4.6%；95%可信区间[CI]，3.6%-5.8%)。与导管相关的55例(3.6%)，非导管相关的深静脉血栓11例(0.7%)，肺血栓9例(0.6%)。34%的VTE发生在血小板计数<50×10(9)/L，13%发生在血小板<20×10(9)/L。多因素分析显示，VTE与既往静脉血栓形成(优势比[OR]2.9；95%可信区间1.3~6.6)和移植物抗宿主病(GVHD；OR 2.4；95%CI 1.4~4.0)相关。临床明显出血230例(15.2%；95%CI，13.4%~17.1%)，致命性出血55例(3.6%；95%CI，2.7%~4.7%)。出血与抗凝(OR，3.1；95%CI，1.8-5.5)、移植物抗宿主病(OR，2.4；95%CI，1.8-3.3)和静脉闭塞疾病(OR，2.2；95%CI，1.4-3.6)有关。在HSCT患者中，VTE主要是与导管相关的，比临床上显著的出血少3倍。这些发现值得在选择HSCT患者的VTE预防措施时加以考虑。
Venous thromboembolism (VTE) is increasingly diagnosed among individuals with hematologic malignancies. However, the risk of VTE among patients undergoing hematopoietic stem cell transplantation (HSCT) is unclear. We examined the incidence and risk factors for VTE and bleeding among 1514 patients undergoing in-patient HSCT. No protocolized VTE prophylaxis was used. By HSCT day 180, 75 symptomatic VTE occurred in 70 patients (4.6%; 95% confidence interval [CI], 3.6%-5.8%). Fifty-five (3.6%) were catheter-associated, 11 (0.7%) were non-catheter-associated deep venous thromboses, and 9 (0.6%) were pulmonary emboli. Thirty-four percent of VTE occurred at a platelet count less than 50 x 10(9)/L; 13% occurred at a platelet count less than 20 x 10(9)/L. In multivariate analysis, VTE was associated with prior VTE (odds ratio [OR], 2.9; 95% CI, 1.3-6.6) and with graft-versus-host disease (GVHD; OR, 2.4; 95% CI, 1.4-4.0). Clinically significant bleeding occurred in 230 patients (15.2%; 95% CI, 13.4%-17.1%); 55 patients (3.6%; 95% CI, 2.7%-4.7%) had fatal bleeding. Bleeding was associated with anticoagulation (OR, 3.1; 95% CI, 1.8-5.5), GVHD (OR, 2.4; 95% CI, 1.8-3.3), and veno-occlusive disease (OR, 2.2; 95% CI, 1.4-3.6). In HSCT patients, VTE is primarily catheter-related and 3-fold less common than clinically significant bleeding. These findings warrant consideration when selecting VTE prophylaxis in HSCT patients.