文章：

骨髓增殖性肿瘤合并静脉血栓栓塞的抗栓治疗

Antithrombotic therapy for venous thromboembolism in myeloproliferative neoplasms

原文发布日期：2018-06-26

DOI: 10.1038/s41408-018-0101-8

类型: Current Treatment Algorithm

开放获取: 是

英文摘要：

In myeloproliferative neoplasms (MPNs) the incidence of venous thromboembolism (VTE) is 0.6–1.0 per 100 pt-years, and the rate of recurrence after VTE is 6.0–6.5 per 100 pt-yrs. Vitamin K-antagonists (VKA) reduces the risk of recurrence after VTE at usual sites (i.e., deep venous thrombosis (DVT) of the legs and pulmonary embolism (PE)) by 48–69%, with a rate of recurrent thrombosis per 100 pt-yrs of 3.4–4.7 on VKA and 8.9–9.6 off VKA; VKA discontinuation produces a 2.2-fold increased risk of novel thrombotic events with respect to continuation. However, the rate of both recurrent thrombosis and major bleeding on VKA is higher in MPN patients than in non-MPN patients, and the risk-benefit balance of long-term VKA treatment is challenging. In the absence of strong evidence, the tailored management of MPN-related VTE should operatively consider the risk categories for recurrence and bleed well established in the non-MPN setting. In summary, MPN patients with VTE are candidates for life-long VKA treatment, especially after unprovoked proximal DVT and PE. Aspirin can offer a moderate benefit in those patients who stop anticoagulation. The use of direct oral anticoagulants should be explored aiming to ameliorate the rate of bleeding.

摘要翻译： 

在骨髓增殖性肿瘤（MPN）中，静脉血栓栓塞（VTE）的发生率为每100患者年0.6-1.0例，VTE后的复发率为每100患者年6.0-6.5例。维生素K拮抗剂（VKA）可将常见部位（即下肢深静脉血栓形成和肺栓塞）VTE的复发风险降低48-69%，使用VKA治疗期间每100患者年的血栓复发率为3.4-4.7例，未使用VKA时为8.9-9.6例；停用VKA会导致新发血栓事件的风险相较于继续用药增加2.2倍。然而，MPN患者在使用VKA期间的血栓复发和大出血发生率均高于非MPN患者，长期VKA治疗的风险-效益平衡具有挑战性。在缺乏强有力证据的情况下，MPN相关VTE的个体化管理应实际操作中参考非MPN领域中已确立的复发和出血风险分类。总之，伴有VTE的MPN患者适合终身VKA治疗，尤其是在无诱因的近端深静脉血栓形成和肺栓塞之后。对于停止抗凝治疗的患者，阿司匹林可提供中等程度的获益。应探索直接口服抗凝药的应用，以期改善出血发生率。

原文链接：

Antithrombotic therapy for venous thromboembolism in myeloproliferative neoplasms