文章：

骨髓增殖性肿瘤患者直接口服抗凝药物的使用模式与结局

Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients

原文发布日期：2021-11-05

DOI: 10.1038/s41408-021-00566-5

类型: Article

开放获取: 是

英文摘要：

Myeloproliferative neoplasms (MPNs) are characterized by an increased risk of thrombosis and bleeding. Vitamin K antagonists (VKAs) are the historic anticoagulant recommended for use in MPNs. Direct oral anticoagulants (DOACs) are being increasingly used in general and cancer populations. However, DOAC safety and efficacy in MPN patients remains unclear. We characterized real-world practice patterns of DOAC use in MPN patients and evaluated thrombosis and bleeding risk. We conducted a retrospective cohort study of 133 MPN patients prescribed DOACs for venous thromboembolism (VTE), atrial fibrillation, or arterial thromboembolism (ATE). Practice patterns including duration of anticoagulation, dosing, and concomitant use of antiplatelet/cytoreductive agents, were heterogeneous among MPN patients. The 1-year cumulative incidence of thrombosis and bleeding on DOAC was 5.5% (1.5–9.5%) and 12.3% (6.4–18.2%) respectively. In comparison, reported bleeding rates in MPN patients on DOAC and VKAs are 1–3%. On multivariable analysis, prior history of thrombosis, use of dabigatran or edoxaban, and younger age were significantly associated with a higher risk of recurrent thrombosis, while leukocytosis was associated with a higher risk of bleeding on DOAC. The higher-than-expected bleeding rate found in our study indicates the continued need for rigorous evaluation of DOACs in this population.
 

摘要翻译： 

骨髓增殖性肿瘤（MPN）具有血栓形成和出血风险增加的特征。维生素K拮抗剂（VKA）是历史上推荐用于MPN的抗凝药物。直接口服抗凝药（DOAC）在普通人群及癌症患者中的使用日益广泛，但其在MPN患者中的安全性和有效性尚不明确。本研究旨在描述MPN患者使用DOAC的真实实践模式，并评估其血栓形成和出血风险。我们对133名因静脉血栓栓塞（VTE）、心房颤动或动脉血栓栓塞（ATE）而接受DOAC治疗的MPN患者进行了回顾性队列研究。MPN患者的实践模式存在异质性，包括抗凝治疗时长、剂量以及与抗血小板药物/细胞减灭剂的联合使用。使用DOAC治疗期间，1年累积血栓形成发生率和出血发生率分别为5.5%（1.5–9.5%）和12.3%（6.4–18.2%）。相比之下，文献报道的MPN患者使用DOAC和VKA的出血率为1–3%。多变量分析显示，既往血栓病史、使用达比加群或依度沙班以及较年轻的年龄与更高的复发性血栓形成风险显著相关，而白细胞增多与DOAC治疗期间更高的出血风险相关。本研究中发现的出血率高于预期，表明仍需对该人群进行DOAC的严格评估。

原文链接：

Practice patterns and outcomes of direct oral anticoagulant use in myeloproliferative neoplasm patients