Nízkomolekulární hepariny v tromboprofylaxi během indukční chemoterapie u pacientů s mnohočetným myelomem
Authors:
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
Authors‘ workplace:
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
Published in:
Klin Onkol 2011; 24(4): 281-286
Category:
Original Articles
Overview
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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