文章：

细胞减灭药物联合抗血小板和抗血栓治疗骨髓增殖性肿瘤患者短暂性脑缺血发作或缺血性卒中后的获益-风险特征

Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms

原文发布日期：2018-02-28

DOI: 10.1038/s41408-018-0048-9

类型: Article

开放获取: 是

英文摘要：

We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.

摘要翻译： 

我们分析了597例出现短暂性脑缺血发作（TIA，n=270）或缺血性卒中（IS，n=327）的骨髓增殖性肿瘤（MPN）患者。治疗方案包括阿司匹林、口服抗凝药和细胞减灭药物。复合终点事件（复发性TIA和IS、急性心肌梗死[AMI]及心血管[CV]死亡）的发生率在索引事件后一年和五年分别为4.21%和19.2%，该估值低于普通人群报道数据，出乎意料。患者倾向于复现首次临床表现（复发性TIA和IS的风险比[HR]分别为2.41和4.41）；复发性TIA的其他影响因素包括既往TIA史（HR:3.40）和微血管障碍（HR:2.30）；而复发性IS的影响因素为动脉高血压（HR:4.24）和MPN诊断后发生的IS（HR:4.47）。心血管死亡风险的预测因素包括年龄超过60岁（HR:3.98）、索引IS事件（HR:3.61）以及MPN诊断后发生的索引事件（HR:2.62）。细胞减灭治疗是显著保护性因素（HR:0.24）。大出血发生率与普通人群相近（0.90/100患者-年）。结论：MPN患者TIA和IS后的长期临床结局甚至优于普通人群，表明抗血栓与细胞减灭治疗具有优势性的获益-风险特征。

原文链接：

Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms