凝血障碍仍然是急性早幼粒细胞白血病（APL）患者治疗中的主要挑战。新型分化剂提高了这些患者的生存率，但凝血功能的干扰仍然对其预后产生影响。最令人担忧的凝血障碍是出血，这并不是 APL 早期死亡的常见原因。尽管如此，对于 APL 致命性出血的高风险还没有一致的预测因素。在这种情况下，纤溶系统已被确定为 APL 凝血病中的关键角色。然而，目前的 APL 管理指南很少考虑测量纤溶系统的测试，而更重视密切监测常规凝血测试和血小板计数以识别凝血病。最近，粘弹性测试已在确定整体止血方面发挥了作用，并已广泛用于在选定的临床环境中“诊断”纤溶亢进。在这篇综述中，我们试图描述诊断 APL 凝血病的风险评估模型，描述粘弹性测试在这种情况下的可能应用，并说服临床医生重新考虑使用抗纤溶药物来提高 APL 患者的生存率。© 2024 作者。

Coagulopathy continues to be a major challenge in the management of patients with acute promyelocytic leukemia (APL). Novel differentiating agents have led to improved survival in these patients, but perturbations in coagulation continue to have an impact on their prognosis. The most worrisome of coagulation disturbances is bleeding, which is not an uncommon cause of early death in APL. Despite this, there are no consistent predictors of this high risk of fatal hemorrhage in APL. In this context, the fibrinolytic system has been identified as a crucial role player in APL coagulopathy. However, the current guidelines for the management of APL give little regard to tests that measure the fibrinolytic system while giving more importance to close monitoring of conventional coagulation tests and platelet counts to identify the coagulopathy. More recently, viscoelastic tests have come to usefulness in determining global hemostasis and have been widely used for "diagnosing" hyperfibrinolysis in selected clinical settings. In this review, we attempt to describe risk assessment models for diagnosing APL coagulopathy, describe the possible application of viscoelastic tests in this setting, and persuade clinicians to reconsider the use of antifibrinolytics to improve survival of APL patients.© 2024 The Authors.