Prediction of thrombotic events in patients with autoimmune hemolytic anemia: a multicenter retrospective observational study.

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thrombosis and Thrombolysis Pub Date : 2025-06-22 DOI:10.1007/s11239-025-03129-8

Lucie Carneiro Esteves, Lucile Grange, Jean-Baptiste Gaultier, Baptiste Gramont, Emilie Chalayer, Martin Killian

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引用次数: 0

Abstract

Background: Autoimmune hemolytic anemia (AIHA) is recognized to increase the risk of thrombotic events (TE), including venous thromboembolism (VTE) and arterial thromboembolism (ATE), but little is known about specific risk factors and characteristics.

Methods: This retrospective multicenter observational study, sought to assess TE incidence, identify associated thrombotic risk factors and assess the external validity of the Padua score in AIHA for predicting VTE.

Results: TE incidence during the study period was 25% (CI95%: 17-36), consisting of 19 VTE in 16 patients (18% [CI95%: 9-28]) and 11 ATE in 7 (8% [CI95%: 4-16]). A high number (≥ 5) of hemolysis attacks was associated with overall TE (OR 6.9 [CI95%: 1-82], p = 0.03). Univariate analysis confirmed splenectomy and VTE history as the strongest VTE-related risk factors (OR 7.5 [CI95%: 1-44], p = 0.009 and OR 3.8 [CI95%: 1-14], p = 0.04), whereas having primary warm AIHA was identified as a novel risk factor (3.1 [1-11] p = 0.05) which needs to be confirmed in further studies. ATE risk factors were age≥ 80 years at diagnosis (OR 8.9 [CI95%: 1-68] p = 0.02), and having ≥ 3 cardiovascular risk factors (OR 8.9 [CI95%: 1-70] p = 0.01). The area under the Receiver Operating Characteristic curve of the Padua score was 0.66.

Conclusions: TE incidence is high in AIHA, especially when there are repeated hemolysis attacks and associated VTE and/or ATE-related risk factors, thus warranting the conduct of prospective clinical trials to allow for an improved TE risk stratification and to design adapted management for both VTE and ATE.

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自身免疫性溶血性贫血患者血栓事件的预测：一项多中心回顾性观察性研究

背景：自身免疫性溶血性贫血（AIHA）被认为会增加血栓事件（TE）的风险，包括静脉血栓栓塞（VTE）和动脉血栓栓塞（ATE），但对具体的危险因素和特征知之甚少。方法：本回顾性多中心观察性研究旨在评估血栓栓塞发生率，确定相关血栓形成危险因素，并评估AIHA中Padua评分预测静脉血栓栓塞的外部有效性。结果：研究期间TE发生率为25% (CI95%: 17-36)，其中VTE 19例16例（18% [CI95%: 9-28]）， ATE 11例7例（8% [CI95%: 4-16]）。溶血发作次数高（≥5次）与总TE相关（OR 6.9 [CI95%: 1-82], p = 0.03）。单因素分析证实脾切除术和静脉血栓栓塞史是静脉血栓栓塞相关的最强危险因素（OR为7.5 [CI95%: 1-44], p = 0.009， OR为3.8 [CI95%: 1-14], p = 0.04），而原发性温暖性AIHA被确定为新的危险因素（3.1 [1-11]p = 0.05），有待进一步研究证实。ATE的危险因素为诊断时年龄≥80岁（OR 8.9 [CI95%: 1-68] p = 0.02），有≥3个心血管危险因素（OR 8.9 [CI95%: 1-70] p = 0.01）。Padua评分的受试者工作特征曲线下面积为0.66。结论：AIHA患者TE发病率高，特别是当有反复溶血发作和相关静脉血栓栓塞和/或静脉血栓栓塞相关危险因素时，因此有必要进行前瞻性临床试验，以改善TE风险分层，并设计适合静脉血栓栓塞和静脉血栓栓塞的治疗方案。

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来源期刊

Journal of Thrombosis and Thrombolysis 医学-外周血管病

CiteScore

9.20

自引率

0.00%

发文量

112

审稿时长

4-8 weeks

期刊介绍： The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.