Annals of Internal Medicine ( IF 39.2 ) Pub Date : 2018-01-16 , DOI: 10.7326/m17-0028 Malin Hultcrantz 1 , Magnus Björkholm 2 , Paul W Dickman 3 , Ola Landgren 4 , Åsa R Derolf 2 , Sigurdur Y Kristinsson 5 , Therese M L Andersson 3
Patients with myeloproliferative neoplasms (MPNs) are reported to be at increased risk for thrombotic events. However, no population-based study has estimated this excess risk compared with matched control participants.
To assess risk for arterial and venous thrombosis in patients with MPNs compared with matched control participants.
Matched cohort study.
Population-based setting in Sweden from 1987 to 2009, with follow-up to 2010.
9429 patients with MPNs and 35 820 matched control participants.
The primary outcomes were rates of arterial and venous thrombosis. Flexible parametric models were used to calculate hazard ratios (HRs) and cumulative incidence with 95% CIs.
The HRs for arterial thrombosis among patients with MPNs compared with control participants at 3 months, 1 year, and 5 years were 3.0 (95% CI, 2.7 to 3.4), 2.0 (CI, 1.8 to 2.2), and 1.5 (CI, 1.4 to 1.6), respectively. The corresponding HRs for venous thrombosis were 9.7 (CI, 7.8 to 12.0), 4.7 (CI, 4.0 to 5.4), and 3.2 (CI, 2.9 to 3.6). The rate was significantly elevated across all age groups and was similar among MPN subtypes. The 5-year cumulative incidence of thrombosis in patients with MPNs showed an initial rapid increase followed by gentler increases during follow-up. The HR for venous thrombosis decreased during more recent calendar periods.
No information on individual laboratory results or treatment.
Patients with MPNs across all age groups have a significantly increased rate of arterial and venous thrombosis compared with matched control participants, with the highest rates at and shortly after diagnosis. Decreases in the rate of venous thrombosis over time likely reflect advances in clinical management.
The Cancer Research Foundations of Radiumhemmet, Blodcancerfonden, the Swedish Research Council, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, the Adolf H. Lundin Charitable Foundation, and Memorial Sloan Kettering Cancer Center.
中文翻译:
骨髓增生性肿瘤患者发生动脉和静脉血栓形成的风险:一项基于人群的队列研究。
据报道患有骨髓增生性肿瘤(MPN)的患者发生血栓形成事件的风险增加。然而,与匹配的对照参与者相比,没有一项基于人群的研究估计出这种过度风险。
为了评估MPN患者与相匹配的对照组参与者发生动脉和静脉血栓形成的风险。
配对队列研究。
1987年至2009年在瑞典以人口为基础,并在2010年采取了后续行动。
9429名MPN患者和35 820名匹配的对照组参与者。
主要结果是动脉和静脉血栓形成的发生率。灵活的参数模型用于计算危险比(HRs)和95%CI的累积发生率。
与对照组相比,MPN患者在3个月,1年和5年时的动脉血栓形成的HRs为3.0(95%CI,2.7至3.4),2.0(CI,1.8至2.2)和1.5(CI,1.4)至1.6)。静脉血栓形成的相应心率分别为9.7(CI,7.8至12.0),4.7(CI,4.0至5.4)和3.2(CI,2.9至3.6)。在所有年龄组中,该比率均显着升高,并且在MPN亚型中相似。MPN患者的5年累积血栓形成发生率显示出最初的快速增加,随后在随访期间轻度增加。在最近的日历期间,静脉血栓形成的HR下降。
没有有关单个实验室结果或治疗的信息。
与匹配的对照组参与者相比,所有年龄段的MPN患者的动脉和静脉血栓形成率均显着增加,在诊断时和诊断后不久发生率最高。随着时间的流逝,静脉血栓形成率的下降可能反映了临床管理的进步。
Radiumhemmet癌症研究基金会,Blodcancerfonden,瑞典研究委员会,斯德哥尔摩县议会与Karolinska研究所之间的医学培训和临床研究区域协议,Adolf H. Lundin慈善基金会和斯隆·凯特琳纪念癌症中心。