Abstract：
BACKGROUND: Rates of venous thromboembolism (VTE) are increasing in people with cystic fibrosis (PwCF). Providers treating VTE in PwCF have reported low confidence concerning anticoagulant drug selection, dose, duration, and drug-drug interactions. As there are currently no published reports regarding management of VTE in PwCF, our objective was to describe the management of VTE in PwCF.
METHODS: PwCF and VTE at the University of Utah Health were identified through electronic medical record searches. Patients were categorized into one of three treatment groups: warfarin, direct oral anticoagulant (DOAC), and low molecular weight heparin (LMWH). The primary outcome was episodes of major bleeding. Secondary outcomes included clinically relevant nonmajor (CRNM) bleeding.
RESULTS: Nine PwCF with a total of 12 unique VTE episodes were included in the study, with all but one episode associated with a peripherally inserted central catheter (PICC). Of the 12 VTE cases, 25% were treated with warfarin, 50% with a DOAC, and 25% with LMWH. There were no episodes of major bleeding and only one episode of CRNM bleeding (Hemoptysis) in the LMWH group. All anticoagulant doses and durations generally followed guidelines for persons without CF. DOACs were the most common VTE treatment, at doses and duration consistent with guidelines for persons without CF, with no major or CRNM bleeding.
CONCLUSIONS: VTE treatment in PwCF is generally consistent with guidelines for persons without CF with low rates of bleeding. DOACs are a potential option for treatment of VTE in PwCF, but more research is needed.
METHODS: PwCF and VTE at the University of Utah Health were identified through electronic medical record searches. Patients were categorized into one of three treatment groups: warfarin, direct oral anticoagulant (DOAC), and low molecular weight heparin (LMWH). The primary outcome was episodes of major bleeding. Secondary outcomes included clinically relevant nonmajor (CRNM) bleeding.
RESULTS: Nine PwCF with a total of 12 unique VTE episodes were included in the study, with all but one episode associated with a peripherally inserted central catheter (PICC). Of the 12 VTE cases, 25% were treated with warfarin, 50% with a DOAC, and 25% with LMWH. There were no episodes of major bleeding and only one episode of CRNM bleeding (Hemoptysis) in the LMWH group. All anticoagulant doses and durations generally followed guidelines for persons without CF. DOACs were the most common VTE treatment, at doses and duration consistent with guidelines for persons without CF, with no major or CRNM bleeding.
CONCLUSIONS: VTE treatment in PwCF is generally consistent with guidelines for persons without CF with low rates of bleeding. DOACs are a potential option for treatment of VTE in PwCF, but more research is needed.
摘要：
背景：囊性纤维化（PwCF）患者静脉血栓栓塞（VTE）的发生率正在增加。在PwCF中治疗VTE的提供者报告了关于抗凝药物选择的低置信度，剂量,持续时间,和药物-药物相互作用。由于目前尚无有关PwCF中VTE管理的公开报告，我们的目的是描述PwCF中VTE的管理。
方法：通过电子病历搜索确定犹他大学健康大学的PwCF和VTE。患者分为三个治疗组之一：华法林，直接口服抗凝剂（DOAC），和低分子量肝素(LMWH)。主要结果是大出血发作。次要结果包括临床相关非主要（CRNM）出血。
结果：本研究纳入了9个PwCF，共12个独特的VTE发作，除1例与外周置入中心静脉导管(PICC)相关外,所有病例均发生。在12例VTE病例中,25%接受华法林治疗,50%的DOAC，和25%与LMWH。在LMWH组中，没有大出血发作，只有一次CRNM出血（咯血）发作。所有抗凝剂剂量和持续时间通常遵循无CF者的指南。DOAC是最常见的VTE治疗，剂量和持续时间与无CF者指南一致，无大出血或CRNM出血。
结论：PwCF中的VTE治疗通常与无CF患者出血率低的指南一致。DOAC是治疗PwCF中VTE的潜在选择，但是需要更多的研究。
方法：通过电子病历搜索确定犹他大学健康大学的PwCF和VTE。患者分为三个治疗组之一：华法林，直接口服抗凝剂（DOAC），和低分子量肝素(LMWH)。主要结果是大出血发作。次要结果包括临床相关非主要（CRNM）出血。
结果：本研究纳入了9个PwCF，共12个独特的VTE发作，除1例与外周置入中心静脉导管(PICC)相关外,所有病例均发生。在12例VTE病例中,25%接受华法林治疗,50%的DOAC，和25%与LMWH。在LMWH组中，没有大出血发作，只有一次CRNM出血（咯血）发作。所有抗凝剂剂量和持续时间通常遵循无CF者的指南。DOAC是最常见的VTE治疗，剂量和持续时间与无CF者指南一致，无大出血或CRNM出血。
结论：PwCF中的VTE治疗通常与无CF患者出血率低的指南一致。DOAC是治疗PwCF中VTE的潜在选择，但是需要更多的研究。
