文章：

在经典型骨髓增殖性肿瘤中，COVID-19 感染期间原发性血小板增多症发生静脉血栓栓塞的风险最高

Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19

原文发布日期：2021-02-04

DOI: 10.1038/s41408-021-00417-3

类型: Article

开放获取: 是

英文摘要：

In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (−23.3%, p < 0.0001) than in PV (−16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
 

摘要翻译： 

在一项欧洲多中心回顾性研究中，纳入了162例合并骨髓增殖性肿瘤（MPN）的COVID-19患者，包括原发性血小板增多症（ET，48例）、真性红细胞增多症（PV，42例）、骨髓纤维化（MF，56例）及纤维化前骨髓纤维化（pre-PMF，16例）。共记录到14例患者发生15次主要血栓事件（3例动脉血栓和12例静脉血栓），其中除1例外均接受低分子肝素预防治疗。经竞争死亡风险校正后，60天随访期内动脉与静脉血栓栓塞事件（VTE）累积发生率达8.5%。值得注意的是，12例VTE中有8例发生于ET患者。值得关注的是，与COVID-19前末次随访相比，MPN患者在确诊COVID-19时血小板计数显著降低（p<0.0001）。其中ET患者血小板下降幅度（-23.3%，p<0.0001）显著高于PV患者（-16.4%，p=0.1730），且该下降与肺炎更高死亡率相关（p=0.0010）。通过单变量分析筛选临床相关且统计学显著的血栓预测因素后，经多变量模型检验发现，转入重症监护室（SHR=3.73，p=0.029）、中性粒细胞/淋巴细胞比值（SHR=1.1，p=0.001）及ET表型（SHR=4.37，p=0.006）是独立危险因素。ET相关VTE易感性增强及其伴随的肺炎高死亡率可能存在共同的生物学机制，值得深入探究以制定包含抗血小板药物在内的新型抗血栓方案。

原文链接：

Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19