文章：

羟基脲可预防骨髓增殖性肿瘤患者的动脉和晚期静脉血栓复发，但对门脉-肠系膜静脉系统无效：1500例汇总分析

Hydroxyurea prevents arterial and late venous thrombotic recurrences in patients with myeloproliferative neoplasms but fails in the splanchnic venous district. Pooled analysis of 1500 cases

原文发布日期：2018-11-12
DOI: 10.1038/s41408-018-0151-y

类型: Article

开放获取: 是

英文摘要：

We collected 1500 patients with myeloproliferative neoplasms (MPN) and arterial or venous thrombosis (935/565), pooling three independent cohorts previously reported. Long-term treatment with antiplatelet drugs or vitamin K-antagonists (VKA) was given to 1391 (92.7%) patients; 975 (65%) patients received hydroxyurea (HU). We recorded 348 recurrences (venous in 142 cases) over 6075 patient-years, with an incidence rate of 5.7 per 100 pt-years (95% CI 5.1–6.4). The site of the first thrombosis predicted the site of recurrence. Independent factors influencing the rate of novel arterial thrombosis were HU (HR 0.67, 95% CI 0.46–0.98), antiplatelet treatment (HR 0.54, 95% CI 0.35–0.82), and VKA (HR 0.58, 95% CI 0.35–0.96). On the contrary, the recurrence of venous thromboses was significantly diminished only by VKA (HR 0.60, 95% CI 0.37–0.95), while HU prevented late but not early recurrences after venous thrombosis at common sites. Of note, we failed to demonstrate a positive effect of HU in the prevention of recurrent splanchnic vein thrombosis. In conclusion, in MPN patients, HU plays a role in the prevention of arterial thrombosis, together with aspirin and VKA, whereas its action in the prevention of recurrent venous thrombosis is uncertain. Such findings call for future studies to optimize and personalize secondary prophylaxis after MPN-related thrombosis.

摘要翻译： 

我们收集了1500例患有骨髓增殖性肿瘤（MPN）伴动脉或静脉血栓形成（935例动脉/565例静脉）的患者，汇总了三个先前报告的独立队列。其中1391例（92.7%）患者长期接受抗血小板药物或维生素K拮抗剂（VKA）治疗；975例（65%）患者接受羟基脲（HU）治疗。在6075患者年的随访期间，我们记录了348例复发事件（其中142例为静脉血栓），发生率为每100患者年5.7例（95%置信区间5.1-6.4）。首次血栓形成部位可预测复发部位。影响新发动脉血栓发生率的独立因素包括羟基脲（风险比0.67，95%置信区间0.46-0.98）、抗血小板治疗（风险比0.54，95%置信区间0.35-0.82）和维生素K拮抗剂（风险比0.58，95%置信区间0.35-0.96）。相反，静脉血栓复发仅被维生素K拮抗剂显著降低（风险比0.60，95%置信区间0.37-0.95），而羟基脲仅能预防常见部位静脉血栓的晚期复发而非早期复发。值得注意的是，我们未能证实羟基脲在预防内脏静脉血栓复发方面具有积极作用。总之，在MPN患者中，羟基脲与阿司匹林和维生素K拮抗剂共同在预防动脉血栓中发挥作用，而其预防静脉血栓复发的作用尚不明确。这些发现提示未来需要开展研究以优化和个性化MPN相关血栓后的二级预防策略。

原文链接：

Hydroxyurea prevents arterial and late venous thrombotic recurrences in patients with myeloproliferative neoplasms but fails in the splanchnic venous district. Pooled analysis of 1500 cases