Blood:抗凝血酶替代预防静脉血栓栓塞的效果

2020-05-02 QQY MedSci原创

强化抗凝血酶和肝素预防并不能百分比地预防VTE的发生。 纤维蛋白原浓缩物可增加血栓形成风险,应限制用于出血患者。

正在接受急性淋巴细胞白血病(ALL)治疗的患者有血栓形成的风险,部分原因是由于使用了L-天冬酰胺酶(L-ASP)。抗凝血酶(AT)替代已被建议用来预防静脉血栓栓塞(VTE),从而可能增加ASP暴露。

在本研究中,研究人员报告了在儿科相关的前瞻性研究(GRAALL-2005)中预防性替代治疗的结果。

2006年-2014年,共784位新确诊的费城染色体(Ph)阴性的ALL成人患者。VTE的发生率为16%,其中69%是发生在诱导治疗期间。大部分患者(87%)接受AT替代治疗。排除未接受L-ASP治疗或采用L-ASP治疗前已出现血栓的患者后,AT替代对VTE的发生率无显著影响(8% vs 14%)。应用浓缩纤维蛋白原与VTE风险增加有关(17% vs 9%),但输注新鲜冰冻血浆没有影响。肝素预防与VTE风险增加有关(13% vs 7%)。预防措施与3-4级出血并发症风险增加无关。L-ASP再入术后VTE复发率为3%(1/34).

在所有接受L-ASP治疗的患者中,使用纤维蛋白原浓缩物可能增加血栓形成的风险,应限制仅用于罕见的纤维蛋白原减少引起的出血患者。虽然采用强化AT替代治疗作为额外的预防措施,患者还是出现了静脉血栓栓塞。

虽然这项大规模的描述性研究并不能证明这些预防措施的有效性,但它为指导未来的试验设计提供了重要的见解。

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    2020-08-08 fusion
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    2020-07-11 nymo
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    2021-03-06 xue8602
  4. [GetPortalCommentsPageByObjectIdResponse(id=1698090, encodeId=85f91698090cb, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sat Aug 08 16:17:12 CST 2020, time=2020-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1951515, encodeId=b28f195151560, content=<a href='/topic/show?id=03ba5524837' target=_blank style='color:#2F92EE;'>#抗凝血酶#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55248, encryptionId=03ba5524837, topicName=抗凝血酶)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=560d188, createdName=nymo, createdTime=Sat Jul 11 17:17:12 CST 2020, time=2020-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1955487, encodeId=c869195548e4d, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Mar 06 04:17:12 CST 2021, time=2021-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047056, encodeId=7321104e0566c, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sat May 02 19:17:12 CST 2020, time=2020-05-02, status=1, ipAttribution=)]
    2020-05-02 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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