新诊断多发性骨髓瘤的血栓栓塞和出血：发生率、风险概况和血栓预防模式

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-08-01 DOI:10.1016/j.rpth.2025.103162

Lea Vospernik , Hermine Agis , Cihan Ay , Lina Rüsing , Heinz Gisslinger , Christina Brunbauer , Clara Sophie Michel , Ingrid Simonitsch-Klupp , Alexandra Kaider , Maria-Theresa Krauth , Julia Riedl

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引用次数: 0

摘要

背景：指南建议，由于静脉血栓栓塞（VTE）的高风险，使用免疫调节药物治疗的多发性骨髓瘤（MM）患者应采用药物血栓预防。目的分析MM患者静脉血栓栓塞和出血的发生率、风险概况和血栓预防模式。方法本队列研究纳入2012年1月至2022年1月在本中心接受诱导治疗的所有连续新诊断MM患者。记录诊断时的特征，抗骨髓瘤治疗，血栓预防以及2年随访期间的血栓和出血事件。结果293例患者中，纳入208例。随访期间，静脉血栓栓塞19例（9.1%），出血35例（16.8%），大出血14例（6.7%）。IMPEDE-VTE评分预测VTE，但SAVED评分不能预测VTE。在诊断后(1)和具有里程碑意义的3个月(2)，阿司匹林与标准抗凝剂（低分子肝素或维生素K拮抗剂）相比，直接口服抗凝剂与无抗栓治疗相比，两年静脉血栓栓塞累积发生率分别为：(1)18.73% (95% CI: 7.43-33.97) vs 2.78% (95% CI: 0.21-12.6) vs 4.00% (95% CI: 0.27-17.36) vs 9.88% (95% CI: 5.03-16.67); (2) 12.46% (95% CI: 4.48-24.74) vs 5.56% (95% CI: 5.56%)：0.34-23.06) vs . 0.00% vs . 10.51% （95% CI: 4.88-18.64）。大出血率在抗血栓策略之间没有显著差异。结论：我们观察到新诊断的MM患者静脉血栓栓塞和出血的发生率很高。与阿司匹林或不使用抗血栓治疗相比，使用抗凝治疗包括直接口服抗凝药物与静脉血栓栓塞风险降低的趋势相关。无论采取何种抗血栓策略，出血风险都很高。

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Thromboembolism and bleeding in newly diagnosed multiple myeloma: rates, risk profile, and patterns of thromboprophylaxis

Background

Guidelines suggest pharmacological thromboprophylaxis for patients with multiple myeloma (MM) treated with immunomodulatory drugs due to a high risk of venous thromboembolisms (VTE).

Objectives

To analyze rates of VTE and bleeding, risk profiles, and patterns of thromboprophylaxis in MM patients.

Methods

For this cohort study, all consecutive patients with newly diagnosed MM between January 2012 and January 2022 who received induction treatment at our center were included. Characteristics at time of diagnosis, antimyeloma treatment, thromboprophylaxis, and thrombotic and bleeding events during 2-year follow-up were recorded.

Results

Of 293 patients screened, 208 were included. During follow-up, VTE occurred in 19 (9.1%) patients, any bleeding in 35 (16.8%), and major bleeding in 14 (6.7%). IMPEDE-VTE score predicted VTE, but SAVED score did not. Two-year cumulative incidences of VTE by type of thromboprophylaxis prescribed after diagnosis (1) and at landmark 3 months (2) for aspirin versus standard anticoagulation (low molecular weight heparin or vitamin K antagonist) versus direct oral anticoagulants versus no antithrombotic therapy were (1) 18.73% (95% CI: 7.43-33.97) versus 2.78% (95% CI: 0.21-12.6) versus 4.00% (95% CI: 0.27-17.36) versus 9.88% (95% CI: 5.03-16.67) and (2) 12.46% (95% CI: 4.48-24.74) versus 5.56% (95% CI: 0.34-23.06) versus 0.00% versus 10.51% (95% CI: 4.88-18.64), respectively. Major bleeding rates did not significantly differ between antithrombotic strategies.

Conclusion

We observed a high rate of VTE and bleeding in patients with newly diagnosed MM. Use of anticoagulant therapy including direct oral anticoagulants was associated with a trend toward reduced risk of VTE compared with aspirin or no antithrombotic therapy. Bleeding risk was high irrespective of antithrombotic strategy.

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