癌症相关血栓和血小板减少症的抗凝治疗：回顾性图表回顾

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-01-01 DOI:10.1016/j.rpth.2025.102684

Umaima Abbas , Robin MacKenzie , Ushra Khan , Rija Fatima , Tzu-Fei Wang , Rong Luo , Caroline Hamm , Andrea Cervi

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引用次数: 0

摘要

癌症相关血栓（CAT）患者复发血栓和出血的风险增加，特别是如果有治疗或疾病相关的血小板减少症。虽然直接口服抗凝剂（DOACs）用于治疗CAT，但低分子肝素（LMWH）仍然被推荐用于伴有血小板减少的CAT。目的：本研究旨在确定与低分子肝素相比，DOACs治疗CAT和血小板减少患者静脉血栓栓塞（VTE）和出血的复发率。方法回顾性分析CAT合并血小板减少症患者（血小板计数≤10万/μL）的临床资料。主要结局包括静脉血栓栓塞复发率和超过90天的大出血。结果42例患者符合纳入标准；实体器官恶性肿瘤20例（47.6%），血液恶性肿瘤22例（52.4%）。血栓栓塞后7 d内血小板计数2.5万/μL 3例（7.1%），2.5万~ 5万/μL 9例（21.4%），5万~ 10万/μL 19例（45.2%）。16例患者（38.1%）接受DOAC初始治疗，19例（45.2%）接受低分子肝素治疗。在doac治疗的患者中，无静脉血栓栓塞复发，前2周有2例临床相关的非大出血事件（12.5%），第2个月有1例轻微出血（6.3%），而低分子肝素治疗的患者在第2个月有1例静脉血栓栓塞复发（5.3%），前2个月有2例临床相关的非大出血事件（10.5%）。结论在血小板减少的CAT患者中，DOACs和低分子肝素治疗的血栓形成率和大出血率相似，尽管基线患者特征的差异可能是混杂因素。CAT合并血小板减少的最佳抗凝治疗需要进一步的前瞻性研究。

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Anticoagulant management of cancer-associated thrombosis and thrombocytopenia: a retrospective chart review

Background

Patients with cancer-associated thrombosis (CAT) are at an increased risk of recurrent thrombosis and bleeding, especially if there is treatment- or disease-related thrombocytopenia. While direct oral anticoagulants (DOACs) are used in the management of CAT, low molecular weight heparin (LMWH) continues to be recommended for CAT with thrombocytopenia.

Objectives

This study aimed to identify the rates of recurrent venous thromboembolism (VTE) and bleeding in patients with CAT and thrombocytopenia treated with DOACs compared with LMWH.

Methods

A retrospective review of patients with CAT and thrombocytopenia (platelet count <100,000/μL) was conducted. Primary outcomes included rates of recurrent VTE and major bleeding over 90 days.

Results

Forty-two patients met the inclusion criteria; 20 (47.6%) had a solid organ malignancy while 22 (52.4%) had a hematologic malignancy. Within the first 7 days of VTE, 3 (7.1%) patients had a platelet count <25,000/μL, 9 (21.4%) had 25,000 to 50,000/μL, and 19 (45.2%) had 50,000 to 100,000/μL. Sixteen patients (38.1%) received a DOAC for initial treatment, while 19 (45.2%) received LMWH. Among patients treated with DOACs, there were no recurrent VTEs, 2 clinically relevant nonmajor bleeding events (12.5%) within the first 2 weeks, and 1 minor bleed (6.3%) in the second month, while those treated with LMWH had 1 recurrent VTE (5.3%) in the second month and 2 clinically relevant nonmajor bleeding events (10.5%) within the first 2 months.

Conclusion

Rates of thrombosis and major bleeding were similar among thrombocytopenic patients with CAT treated with DOACs and LMWH, although differences in baseline patient characteristics can be confounders. Further prospective research on the optimal anticoagulant management of CAT with thrombocytopenia is needed.

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