Nízkomolekulární hepariny v tromboprofylaxi během indukční chemoterapie u pacientů s mnohočetným myelomem

English version

Autoři: P. Kessler ¹; L. Pour ²; E. Gregora ³; M. Zemanová ⁴; M. Penka ⁵; M. Brejcha ⁶; Z. Adam ²; J. Bacovsky ⁴; M. Fenclova ⁷; H. Fraňková ^1,8; P. Hausdorf ⁹; L. Walterová ¹⁰; V. Heinzová ¹¹; M. Holikova ¹²; M. Krejci ²; K. Kubackova ¹³; E. Langrová ⁷; V. Maisnar ¹⁴; I. Meluzinova ¹⁵; Y. Stavarova ¹⁶; J. Straub ¹⁷; V. Scudla ⁴; J. Gumulec ¹⁸; J. Ullrychová ¹⁹; R. Hájek ²; For The Czech Myeloma Group
Působiště autorů: Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic ¹; Department of Internal Medicine – Hematooncology, University Hospital Brno, Czech Republic ²; Department of Haematology, University Hospital Kralovske Vinohrady Praha, Czech Republic ³; Third Department of Internal Medicine, University Hospital Olomouc, Czech Republic ⁴; Department of Haematology, University Hospital Brno, Czech Republic ⁵; Department of Haematology, Centre for Thrombosis and Haemostasis, Hospital Novy Jicin, Czech Republic ⁶; Department of Haematology, Hospital Kladno, Czech Republic ⁷; Department of Haematology, Hospital Trebic, Czech Republic ⁸; Department of Internal Medicine, Hospital Cesky Krumlov, Czech Republic ⁹; Department of Haematology, Regional Hospital, Liberec, Czech Republic ¹⁰; Department of Haematology, Hospital Opava, Czech Republic ¹¹; Department of Oncology, Regional Hospital, Liberec, Czech Republic ¹²; Department of Oncology, Charles University Hospital Motol Praha, Czech Republic ¹³; Department of Haematology, Charles University Hospital Hradec Kralove, Czech Republic ¹⁴; Department of Haematology, Hospital Boskovice, Czech Republic ¹⁵; Department of Haematology, T. Bata’s Regional Hospital, Zlin, Czech Republic ¹⁶; First Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic ¹⁷; Department of Haematology, University Hospital Ostrava, Czech Republic ¹⁸; Department of Haematology, Hospital Decin, Czech Republic ¹⁹
Vyšlo v časopise: Klin Onkol 2011; 24(4): 281-286
Kategorie: Původní práce

Souhrn

Východiska:
Pacienti s mnohočetným myelomem mají vysoké riziko tromboembolické nemoci (TEN), zejména během indukční chemoterapie. Cílem studie bylo zjištění vlivu profylaxe nízkomolekulárním heparinem (LMWH) na incidenci tromboembolických komplikací.

Pacienti a metody:
Analyzovali jsme incidenci tromboembolických příhod u 258 pacientů léčených indukční terapií obsahující vinkristin, doxorubicin nebo idarubicin a dexametazon, následovanou stimulační chemoterapií cyklofosfamidem a G-CSF, a vysokodávkovanou chemoterapií melfalanem. Byly porovnány dvě skupiny těchto pacientů podle praktikované tromboprofylaxe. Pacienti v první skupině (kontrolní, n = 140) buď nebyli léčeni, nebo byli léčeni antikoagulační terapií jen po krátkou dobu, zatímco pacienti ve druhé skupině (profylaktická, n = 118) dostávali standardní profylaxi LMWH po celou dobu indukční chemoterapie. U 102 pacientů byl vyhodnocen profylaktický účinek různých dávek LMWH a porovnán s pacienty bez léčby.

Výsledky:
Standardní profylaxe LMWH významně (p < 0,007) snížila riziko TEN ve srovnání s pacienty bez této profylaxe (3,4 % vs 12,9 %). V analýze podskupiny 102 pacientů bylo zjištěno, že vyšší dávka LMWH (> 70 IU/ kg denně) vedla k 100% účinné profylaxi u 28 pacientů, zatímco nižší dávky byly méně efektivní, 3 pacienti z 39 (7,7 %) prodělali hlubokou žilní trombózu. Naproti tomu TEN byla diagnostikována u 5 z 35 (14,3 %) pacientů bez profylaxe.

Závěr:
Profylaxe LMWH vede k významné redukci rizika tromboembolických komplikací během indukční chemoterapie u pacientů s mnohočetným myelomem. Profylaktický efekt LMWH je závislý na dávce.

Klíčová slova:
mnohočetný myelom – tromboembolická nemoc – prevence – nízkomolekulární heparin

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