骨髓增殖性肿瘤鞘静脉血栓形成的抗凝治疗：系统回顾与元分析》。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-12-01 DOI:10.1016/j.jtha.2024.06.029

Pavlina Chrysafi , Kevin Barnum , Genevieve M. Gerhard , Thita Chiasakul , Arshit Narang , Megan Mcnichol , Nicoletta Riva , Georg Semmler , Bernhard Scheiner , Stefan Acosta , Pierre-Emmanuel Rautou , Mandy N. Lauw , Jonathan Berry , Walter Ageno , Jeffrey I. Zwicker , Rushad Patell

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引用次数: 0

摘要

背景：骨髓增殖性肿瘤（MPN）患者脾静脉血栓形成（SpVT）的最佳抗凝治疗需要平衡出血和血栓复发的风险：我们进行了一项系统回顾和荟萃分析，以评估 MPN-SpVT 患者出血和血栓复发的发生率：方法：我们纳入了≥10例成人MPN-SpVT患者的回顾性或前瞻性英文研究。结果包括复发性静脉血栓（SpVT 和非 SpVT）、动脉血栓和大出血。采用随机效应模型，以DerSimonian-Laird法计算每100个患者年的汇总率及95%置信区间（CIs）：在筛选出的 4624 项研究中，有 9 项研究的 443 名患者被纳入荟萃分析，中位随访时间为 3.5 年。在接受抗凝治疗的 364 名 MPN-SpVT 患者中，每 100 患者年大出血的汇总事件发生率为 2.8（95% CI 1.5-5.1；I2=95%），复发性静脉血栓的汇总事件发生率为 1.4（95% CI 0.8-2.2；I2=72%），动脉血栓的汇总事件发生率为 1.4（95% CI 0.6-3.3；I2=92%）。在79名未接受抗凝治疗的患者（n=4项研究）中，每100名患者年的大出血汇总事件发生率为3.2（95% CI 0.7 - 12.7；I2=97%），复发性静脉血栓发生率为3.5（95% CI 1.8 - 6.4；I2=88%），动脉血栓发生率为1.6（95% CI 0.4 - 6.6；I2=95%）：结论：接受抗凝治疗的 MPN-SpVT 患者面临大出血和血栓复发的巨大风险。有必要开展进一步研究，以确定 MPN-SpVT 患者的最佳抗凝方法。

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Anticoagulation for splanchnic vein thrombosis in myeloproliferative neoplasms: a systematic review and meta-analysis

Background

Optimal anticoagulation management in patients with myeloproliferative neoplasms (MPN) experiencing splanchnic vein thrombosis (SpVT) requires balancing risks of bleeding and recurrent thrombosis.

Objectives

We conducted a systematic review and meta-analysis to assess the incidence of bleeding and thrombosis recurrence in patients with MPN-SpVT.

Methods

We included retrospective or prospective studies in English with ≥10 adult patients with MPN-SpVT. Outcomes included recurrent venous thrombosis (SpVT and non-SpVT), arterial thrombosis, and major bleeding. Pooled rates per 100 patient years with 95% CIs were calculated by DerSimonian–Laird method using random-effects model.

Results

Out of 4624 studies screened, 9 studies with a total of 443 patients were included in the meta-analysis with median follow-up of 3.5 years. In the 364 patients with MPN-SpVT treated with anticoagulation, pooled event rate for major bleeding was 2.8 (95% CI, 1.5-5.1; I² = 95%), for recurrent venous thrombosis was 1.4 (95% CI, 0.8–2.2; I² = 72%), and for arterial thrombosis was 1.4 (95% CI, 0.6-3.3; I² = 92%) per 100 patient years. Among 79 patients (n = 4 studies) who did not receive anticoagulation, pooled event rate for major bleeding was 3.2 (95% CI, 0.7-12.7; I² = 97%), for recurrent venous thrombosis 3.5 (95% CI, 1.8-6.4; I² = 88%), and for arterial thrombosis rate 1.6 (95% CI, 0.4-6.6; I² = 95%) per 100 patient years.

Conclusion

Patients with MPN-SpVT treated with anticoagulation have significant risks for both major bleeding and thrombosis recurrence. Further studies are necessary to determine the optimal anticoagulation approach in patients with MPN-SpVT.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.