直接口服抗凝剂在骨髓增生性肿瘤相关血栓形成的一级和二级预防中有作用吗?

IF 0.9 Q4 HEMATOLOGY
Hemato Pub Date : 2021-12-14 DOI:10.3390/hemato2040053
Uzma Faruqi, K. Breen
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引用次数: 0

摘要

费城染色体阴性骨髓增生性肿瘤(MPN)是一种克隆性造血干细胞疾病。在MPN中,真性红细胞增多症(PV)和原发性血小板增多症(ET)具有较高的血栓形成风险,这可能是该疾病的表现特征。血栓并发症包括动脉和静脉事件,JAK2 V617F突变的存在与更高的风险相关。出现无端血栓的患者,特别是在不寻常的部位,如内脏循环,应筛查是否存在这种突变。从历史上看,华法林是口服抗凝的唯一选择;然而,目前有越来越多的证据和实践表明,在癌症中使用直接口服抗凝血剂。精液随机对照试验表明,与出血情况较好的低分子肝素(LMWH)相比,没有劣效性。根据NICE的建议,DOAC现在是治疗心房颤动和静脉血栓栓塞疾病的一线药物,因此人们对这些药物越来越熟悉。此外,现在有针对性的解药可用。本文综述了DOAC在MPN中的有效性和安全性的证据。虽然尚未进行随机对照试验,但几项回顾性研究和注册数据审查已可重复证明,除了细胞减少外,DOAC是治疗MPN静脉血栓栓塞症的一种有效的抗凝方式。此外,给药方案提供了长期二次预防的选择。DOAC在动脉血栓形成中的应用是未来发展的一个领域,并且已经有一些证据表明其在外周血管疾病中的实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is There a Role for Direct Oral Anticoagulants in the Primary and Secondary Prevention of Myeloproliferative Neoplasm Associated Thrombosis?
Philadelphia chromosome negative myeloproliferative neoplasms (MPN) are clonal haematopoietic stem cell disorders. Of the MPNs, polycythaemia vera (PV) and essential thrombocythaemia (ET) confer a high thrombotic risk which may be the presenting feature of the disease. Thrombotic complications consist of both arterial and venous events and the presence of the JAK2 V617F mutation is associated with higher risk. Patients presenting with an unprovoked thrombus, particularly at an unusual site, e.g., splanchnic circulation, should be screened for the presence of this mutation. Historically, warfarin has been the only option for oral anticoagulation; however, there is now increasing evidence and practise to use direct oral anticoagulants (DOACs) in cancer. The seminal randomised control trials have demonstrated non-inferiority compared to low molecular weight heparin (LMWH) with a preferable bleeding profile. DOACs are now the first line treatment for atrial fibrillation and venous thromboembolic disease, as recommended by NICE, and therefore there is increasing familiarity with these agents. Furthermore, there are now targeted antidotes available. This paper reviews evidence for efficacy and safety of DOACs in MPN. Whilst no randomised control trials have been performed, several retrospective studies and reviews of registry data have reproducibly demonstrated that, alongside cytoreduction, DOACs represent an effective modality of anticoagulation for treatment of venous thromboembolism in MPN. Furthermore, dosing regimens provide the option for longer term secondary prophylaxis. Use of DOACs in arterial thrombosis is an area for future development and there is already some evidence for utility in peripheral vascular disease.
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来源期刊
CiteScore
1.30
自引率
0.00%
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审稿时长
11 weeks
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