Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) often receive antibacterial prophylaxis. Antibacterial agents can cause elevations in the prothrombin time and international normalized ratio (INR). The impact of prophylactic antibacterials on the coagulation profiles and bleeding risk in patients with AML/MDS is unknown. We evaluated patients with AML or MDS who were being admitted to the hospital. The cohort was divided into two groups of patients: (1) those receiving and (2) those not receiving prophylactic antibacterials, at the time of admission. We conducted a retrospective cohort study of adult patients with AML/MDS admitted to Yale-New Haven Hospital between 2015–2019. The study was approved by the Yale Institutional Review Board. Inclusion criteria included patients gt;18 years old with a diagnosis of AML or MDS admitted to the hospital. We identified 150 individual patient encounters with active AML/MDS admitted to Yale-New Haven of which 32 occurred while on and 118 while off antibacterial prophylaxis. Median duration of pre-admission antibacterial exposure was 2 (range: 0.07–24) months. Patients on antibacterial prophylaxis had higher INR (median 1.14 vs. 1.03, p = 0.0002), and higher partial thromboplastin time prolongation (median 26.5 vs. 24.3, p lt; 0.0014), than patients without antibacterial prophylaxis. Patients without antibacterial prophylaxis had higher rates of bleeding using the ISTH-defined criteria (24.6% vs. 6.3%, p = 0.043), including higher rates of ISTH major (2 vs. 0) and clinically relevant bleeding (9 vs. 0). Patients with AML/MDS on antibacterial prophylaxis were more likely to have an abnormal coagulation profile when compared with their counterparts not on prophylaxis. Conversely, rates of bleeding were higher in patients not on prophylaxis. These data suggest that prophylactic antibacterials do not increase bleeding risk in patients with AML/MDS.
Acta Haematol

中文翻译：

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预防性抗菌药物对急性髓系白血病/骨髓增生异常综合征患者凝血曲线和出血的影响

急性髓系白血病 (AML) 和骨髓增生异常综合征 (MDS) 患者经常接受抗菌预防治疗。抗菌药物可导致凝血酶原时间和国际标准化比值 (INR) 升高。预防性抗菌药物对 AML/MDS 患者凝血功能和出血风险的影响尚不清楚。我们评估了入院的 AML 或 MDS 患者。该队列被分为两组患者：（1）入院时接受预防性抗菌药物的患者和（2）未接受预防性抗菌药物的患者。我们对 2015 年至 2019 年耶鲁-纽黑文医院收治的 AML/MDS 成年患者进行了回顾性队列研究。该研究得到了耶鲁大学机构审查委员会的批准。纳入标准包括年龄大于 18 岁、诊断为 AML 或 MDS 入院的患者。我们确定了耶鲁大学纽黑文分校收治的 150 名活动性 AML/MDS 患者，其中 32 名患者在接受抗菌预防治疗期间发生，118 名患者在未接受抗菌预防治疗期间发生。入院前接触抗菌药物的中位持续时间为 2 个月（范围：0.07-24）个月。与未进行抗菌预防的患者相比，接受抗菌预防的患者具有更高的 INR（中位 1.14 对比 1.03，p = 0.0002）和更高的部分凝血活酶时间延长（中位 26.5 对比 24.3，p < 0.0014）。根据 ISTH 定义的标准，未进行抗菌预防的患者出血率较高（24.6% vs. 6.3%，p = 0.043），包括较高的 ISTH 主要出血率（2 vs. 0）和临床相关出血率（9 vs. 0） 。与未接受预防治疗的患者相比，接受抗菌预防治疗的 AML/MDS 患者更有可能出现凝血功能异常。相反，未接受预防的患者出血率较高。这些数据表明预防性抗菌药物不会增加 AML/MDS 患者的出血风险。
血液学报