Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry.
Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry.
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DOI：
10.1186/s13045-016-0242-9
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发表时间：
2016-03-05
影响因子：
28.5
通讯作者：
Study Alliance Leukemia (SAL)
中科院分区：
文献类型：
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作者：
Kaifie A;Kirschner M;Wolf D;Maintz C;Hänel M;Gattermann N;Gökkurt E;Platzbecker U;Hollburg W;Göthert JR;Parmentier S;Lang F;Hansen R;Isfort S;Schmitt K;Jost E;Serve H;Ehninger G;Berdel WE;Brümmendorf TH;Koschmieder S;Study Alliance Leukemia (SAL)
Ph阴性的骨髓增生性肿瘤(MPN)患者，如真性红细胞增多症(PV)、原发性血小板增多症(ET)和原发性骨髓纤维化(PMF)，血栓形成/血栓栓塞症和大出血的风险增加。由于这些事件的发病率和死亡率，抗血小板和/或抗凝剂通常被用作一级和/或二级预防措施。另一方面，与疾病相关的出血并发症(即食道静脉曲张)在MPN患者中很常见。这项分析是为了确定这类事件的频率，识别危险因素，并评估MPN患者队列中的抗血小板/抗凝治疗。研究联盟白血病的MPN登记是一项非干预性前瞻性研究，包括符合世卫组织标准(2008年)的MPN成年患者。对于统计分析，使用描述性方法和显著差异的测试以及列联表来确定血管事件的潜在危险因素的几率。MPN亚型在性别分布、确诊年龄、血细胞计数、LDH水平、JAK2V617F阳性和脾大小(长度)方面存在显著差异。虽然大多数血栓栓子事件发生在MPN诊断时间左右，但三分之一的事件发生在该日期之后。内脏静脉血栓形成多见于PV-MF和MPN-U术后患者。PV-MF术后(OR3.43；95%CI = 1.39~8.48)和脾肿大(OR1.76；95%CI = 1.15~2.71)的患者发生血栓栓塞症的几率显著增加。重大出血的显著风险是既往血栓栓塞症(OR = 2.71；95%CI = 1.36-5.40)、脾肿大(OR = 2.22；95%CI 1.01-4.89)和肝素的使用(OR = 5.64；95%CI = 1.84-17.34)。与其他MPN亚组相比，ET患者的主要出血事件明显较少。总而言之，这份关于德国MPN患者的未经选择的“真实世界”队列的报告揭示了有关MPN的血栓栓塞症和主要出血并发症的患病率、诊断和治疗的重要数据。
Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95 % CI = 1.39–8.48) and splenomegaly (OR 1.76; 95 % CI = 1.15–2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95 % CI = 1.36–5.40), splenomegaly (OR = 2.22; 95 % CI 1.01–4.89), and the administration of heparin (OR = 5.64; 95 % CI = 1.84–17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups. Together, this report on an unselected “real-world” cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.