恶性肿瘤是内脏静脉血栓形成（SpVT）的危险因素。有关癌症相关 SpVT 自然史的数据有限。这是一项单中心回顾性队列研究，纳入了 581 名患有癌症和 SpVT 的成年患者。我们的目的是在癌症相关 SpVT 初次诊断后一年内，描述血小板减少症对大出血以及 SpVT 进展或复发的影响。 39.5% 的患者存在基线血小板减少症（SpVT 诊断后 15 天内血小板<100,000/uL）。共有 39.2% 的患者在 SpVT 诊断后两周内接受了治疗性抗凝治疗。一年一次的大出血累积发生率为 10.7%（95% CI：8.2-13.2），SpVT 复发/进展发生率为 16.2%（95% CI：13.2-19.2）。在多变量回归分析中，抗凝治疗与大出血增加（aRR：1.74，95% CI：1.08-2.81）和 SpVT 进展/复发减少（aRR：0.55，95% CI：0.35-0.86）相关。基线血小板减少症与大出血（aRR：0.76，95% CI：0.43-1.34）或 SpVT 进展/复发（aRR：1.14，95% CI：0.73-1.78）均不独立相关。使用治疗加权逆概率和基线血小板减少症倾向评分进行的二次分析证实，血小板减少症患者的出血风险并未增加（aHR：0.81，95％CI：0.48-1.39）。将血小板视为随时间变化的协变量的多变量分析也没有揭示与大出血的关联（aHR：0.89，95％CI：0.55-1.45）。癌症相关 SpVT 患者经常出现出血和血栓形成进展。抗凝治疗与大出血增加和血栓形成进展减缓相关；血小板减少症不会影响结果。版权所有 © 2024 美国血液学会。

Malignancy is a risk factor for splanchnic vein thrombosis (SpVT). Data on the natural history of cancer-associated SpVT are limited. This was a single-center retrospective cohort study of 581 adult patients with cancer and SpVT. We aimed to characterize the impact of thrombocytopenia on major bleeding and progression or recurrence of SpVT within one year of initial cancer-associated SpVT diagnosis. Baseline thrombocytopenia (platelet < 100,000/uL within 15 days of SpVT diagnosis) was present in 39.5% of patients. A total of 39.2% of patients received therapeutic anticoagulation within two weeks of SpVT diagnosis. The cumulative once-year incidence of major bleeding was 10.7% (95% CI: 8.2-13.2), and for SpVT recurrence/progression was 16.2% (95% CI: 13.2-19.2). In multivariable regression analysis, therapeutic anticoagulation was associated with increased major bleeding (aRR: 1.74, 95% CI: 1.08-2.81) and decreased progression/recurrence of SpVT (aRR: 0.55, 95% CI: 0.35-0.86). Baseline thrombocytopenia was not independently associated with either major bleeding (aRR: 0.76, 95% CI: 0.43-1.34) or progression/recurrence of SpVT (aRR: 1.14, 95% CI: 0.73-1.78). A secondary analysis using inverse probability of treatment weighting with propensity scores for baseline thrombocytopenia corroborated that patients with thrombocytopenia did not have increased bleeding risk (aHR: 0.81, 95% CI: 0.48-1.39). Multivariable analysis treating platelets as a time varying covariate also did not reveal an association with major bleeding (aHR: 0.89, 95% CI: 0.55-1.45). Bleeding and thrombosis progression were frequent in patients with cancer-associated SpVT. Anticoagulation was associated with increased major bleeding and decreased thrombotic progression; thrombocytopenia did not impact outcomes.Copyright © 2024 American Society of Hematology.