肿瘤患者静脉血栓栓塞症的风险评估模型及其应用

静脉血栓栓塞症（VTE）是肿瘤患者常见的并发症和死亡原因。多项研究显示,有效的VTE风险评估模型和恰当的预防性抗凝治疗可以降低肿瘤患者的血栓发生风险。但哪些肿瘤患者需要进行预防性抗凝治疗,需要有效的VTE风险评估模型,对肿瘤患者进行VTE风险分层。对血栓高危人群,在排除抗凝禁忌证后进行预防性抗凝。但肿瘤疾病存在复杂性,不同的病理类型和分期,VTE风险和特点不同,而目前专门针对肿瘤患者的VTE风险评估模型仍然有限,本文将对肿瘤患者的VTE风险评估模型的现状及其应用进行综述。     

肿瘤相关静脉血栓栓塞症中新型口服抗凝药应用进展

目的回顾NOACs在治疗CAVTE中的特点、疗效、不良反应及相关进展,并讨论其在CAVTE中面临的挑战及前景。方法应用PubMed、CNKI、万方数据库和维普中文科技期刊数据库检索系统,以"new oral anticoagulants、cancer-associated venous thromboembolism、low molecular weight heparin"及"新型口服抗凝药、肿瘤相关静脉血栓、低分子肝素"为关键词,检索2009-10-2019-10的相关文献。纳入标准:(1)NOACs;(2)CAVTE;(3)NOACs治疗CAVTE的病例对照研究。根据纳入标准分析文献44篇,其中中文4篇,英文40篇。结果NOACs在治疗肿瘤相关静脉血栓中的疗效不低于传统治疗药物,VTE复发风险低于低分子肝素,在非消化道肿瘤中其主要出血不良反应可耐受,患者依从性较好。但肿瘤患者存在特殊性,CAVTE应用NOACs的抗凝与出血风险评估、抗凝疗程周期、抗凝剂量、不良反应监测和相互作用等方面都面临挑战,均需充分权衡利弊,进行个体化抗凝管理。结论NOACs在CAVTE中的治疗越来越受到关注,应用日益广泛。但NOACs也面临一些挑战,CAVTE应用NOACs的获益需要更多的研究数据支持,而血栓与出血风险的权衡需要大量基于临床经验的个体化治疗。     

肿瘤患者下肢深静脉血栓形成机制及防治

 肿瘤患者下肢深静脉血栓（DVT）的发病率明显高于一般人群，其发生机制包括高凝、血管内皮损伤、血流瘀滞等多种因素。DVT临床危害大，早期诊断及预防性抗凝治疗有重要意义，但目前针对肿瘤患者尚无确定的预防性抗凝治疗标准。     

肿瘤患者静脉血栓栓塞抗凝出血与复发风险研究进展

肿瘤相关静脉血栓栓塞症(cancer-associated venous thromboembolism, CAVTE)为肿瘤患者在疾病进程中的常见并发症和死亡原因。其静脉血栓栓塞症(venous thromboembolism, VTE)复发和抗凝后严重出血的高风险可能会导致治疗延误和死亡率增加。目前, 国内外指南并未推荐对所有门诊患者直接进行一级预防, 但建议在化疗前评估发生静脉血栓栓塞的个体风险。本文对目前肿瘤患者静脉血栓栓塞抗凝出血与复发研究进展以及现行VTE防治指南和VTE风险评估模型进行综述。      

肿瘤患者导管相关性深静脉血栓应用预防性抗凝治疗的临床观察

目的 探讨预防性抗凝治疗对恶性肿瘤患者外周静脉置入中心静脉导管(PICC)后相关性血栓的作用.方法 选取2013年1月至2016年12月间广州医科大学附属第一医院收治的系统治疗前予PICC置管的143例患者的临床资料进行回顾性分析,根据治疗方式不同进行分组,其中化疗过程接受预防性抗凝治疗的95例患者纳入预防性抗凝组,仅...     

妇科肿瘤术后深静脉栓塞的预防和治疗

目的:探讨妇科肿瘤术后深静脉栓塞(deepveinthrombosis,DVT)的预防和治疗方法。方法:回顾分析我院妇科肿瘤术后DVT10例的临床特点、治疗和转归,总结围手术期DVT预防和治疗。结果:全部病例确诊后即进行抗凝、溶栓治疗,血栓完全溶解1例,部分溶解9例,症状均明显改善,无肺栓塞发生。结论:术前纠正贫血,术中操作精细、减轻对髂静脉及其属支的刺激,术后鼓励患者早期下床活动、尽量不用止血药是预防深静脉形成的主要方法;对有高危因素者术后可考虑预防性抗凝治疗;早期诊断、及时进行抗凝、溶栓治疗是安全有效的。     

肿瘤与静脉血栓栓塞症

 肿瘤患者有较高的静脉血栓发生率。研究发现,静脉血栓栓塞症（VTE）可增加肿瘤患者的死亡风险。VTE的发生机制与组织因子（TF）及癌促凝物质（CP）等因素密切相关。患者相关性因素、肿瘤相关性因素及治疗相关性因素均可导致患者VTE发生率增加。应重视对患者危险因素进行评估,对高危患者及早进行预防性抗凝治疗,在诊断VTE后应立即进行急性期治疗及慢性期维持治疗。     

肿瘤相关血栓的形成及其治疗

恶性肿瘤患者易并发静脉血栓形成,是恶性肿瘤患者第二大致死因素。肿瘤并发血栓形成的机制与肿瘤类型、治疗、转移、遗传以及肿瘤本身有关。对肿瘤患者伴发静脉血栓的风险进行评估,针对高危患者给予针对性的预防性抗凝措施,对肿瘤患者提高生命质量和延长生存期有重要意义。     

肿瘤与血栓形成研究进展

血栓形成与肿瘤形成关系密切,其机制与肿瘤本身及释放的因子和治疗相关.大部分肿瘤血栓患者可通过初步筛查检测出来.美国胸科协会已发布抗凝指南,其中低分子肝素抗凝同时亦抗肿瘤.     

癌性血栓及其防治

恶性肿瘤患者易并发血栓栓塞，血栓的发生将影响肿瘤患者的生活质量和生存期。全文就癌性血栓的发生机制、癌症和血栓的关系、癌性血栓的防治及抗凝药物的抗肿瘤作用等问题做一综述。     

The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: strategies for improving VTE prophylaxis in hospitalized cancer patients

The risk for venous thromboembolism (VTE) is high in hospitalized cancer patients, and is associated with an elevated risk for recurrent thrombosis, bleeding complications, and use of health care resources. Thromboembolism is the second leading cause of death in hospitalized cancer patients. Thromboprophylaxis with unfractionated heparin or low-molecular-weight heparins has been clinically proven to reduce the risk for VTE and improve outcomes. However, VTE prophylaxis continues to be underprescribed in cancer patients. Recognizing the clinical burden of VTE in cancer patients, the National Comprehensive Cancer Network (NCCN) recently released guidelines for VTE prevention and management. These NCCN guidelines recommend evidence-based prophylactic anticoagulant therapy for all patients admitted to hospital with a diagnosis of cancer who do not have contraindications to anticoagulant use. However, there continue to be barriers to the implementation of clinical practice guidelines and appropriate use of VTE prophylaxis. Multifaceted active educational and electronic interventions are necessary to raise awareness and reduce the burden of cancer-associated thrombosis and its attendant consequences.     

The impact of thromboprophylaxis on cancer survival: focus on pancreatic cancer

Pancreatic cancer is still a clinical challenge due to its predominantly late diagnosis and the chemoresistance to cytotoxic and target drugs. One of the major complications of pancreatic cancer is venous thromboembolism (VTE). Both ambulatory and hospitalized pancreatic cancer patients are at higher risk of developing VTE. Among patients with unresectable pancreatic cancer, the occurrence of VTE may be associated with a poor prognosis. Furthermore, emerging clinical data strongly suggest that anticoagulant treatment may improve patient survival by decreasing thromboembolic complications as well as by anticancer activity. Given the clinical relevance for both physicians and basic scientists, this article focuses on the experimental and clinical evidence supporting the relation between the coagulation cascade and the invasive and metastatic potential of pancreatic cancer, and suggests that anticoagulant therapy may represent a useful strategy to improve the prognosis of pancreatic cancer patients.     

The impact of thromboprophylaxis on cancer survival: focus on pancreatic cancer

Pancreatic cancer is still a clinical challenge due to its predominantly late diagnosis and the chemoresistance to cytotoxic and target drugs. One of the major complications of pancreatic cancer is venous thromboembolism (VTE). Both ambulatory and hospitalized pancreatic cancer patients are at higher risk of developing VTE. Among patients with unresectable pancreatic cancer, the occurrence of VTE may be associated with a poor prognosis. Furthermore, emerging clinical data strongly suggest that anticoagulant treatment may improve patient survival by decreasing thromboembolic complications as well as by anticancer activity. Given the clinical relevance for both physicians and basic scientists, this article focuses on the experimental and clinical evidence supporting the relation between the coagulation cascade and the invasive and metastatic potential of pancreatic cancer, and suggests that anticoagulant therapy may represent a useful strategy to improve the prognosis of pancreatic cancer patients.     

Thromboprophylaxis with low‐molecular‐weight heparin in medical patients with cancer

Venous thromboembolism (VTE) is a frequent complication of cancer and cancer treatment and is associated with multiple clinical consequences, including recurrent VTE, bleeding, and an increase in the risk of death. Although the risks associated with VTE have been well recognized in surgical cancer patients, there is also considerable and increasing risk in medical cancer patients. VTE risk factors in medical cancer patients include the type and stage of cancer, major comorbid illnesses, current hospitalization, active chemotherapy, hormone therapy, and antiangiogenic agents. Low‐molecular‐weight heparins (LMWHs) are recommended commonly for the prevention of VTE in hospitalized cancer patients and in higher risk ambulatory cancer patients because of their favorable risk‐to‐benefit profile. These agents have demonstrated effectiveness in both the primary and secondary prevention of VTE in medical cancer patients. Extended‐duration anticoagulant therapy is often recommended to reduce the risk of VTE recurrence in patients with cancer. LMWHs are often used for long‐term prophylaxis because of a reduced need for coagulation monitoring, few major bleeding episodes, and once‐daily dosing. Despite clinical and practical benefits, a substantial proportion of medical cancer patients do not receive VTE prophylaxis. To improve the appropriate prevention and treatment of VTE in cancer patients, guidelines have been published recently by the American Society of Clinical Oncology and the National Comprehensive Cancer Network. Widespread dissemination and application of these guidelines are encouraged to improve the appropriate use of these agents and to improve clinical outcomes in medical cancer patients at risk for VTE and its complications. Cancer 2009. © 2009 American Cancer Society.     

Warfarin versus low-molecular-weight heparin therapy in cancer patients

The association between cancer and venous thromboembolism (VTE) is well established. Importantly, VTE is a significant cause of mortality in cancer patients. Although long-term warfarin (Coumadin(trade mark); Bristol-Myers Squibb; New York, NY) therapy is the mainstay of treatment for cancer patients with VTE, there are many practical problems with its use in this population. In particular, achieving therapeutic drug levels is difficult in cancer patients due to the increased risk of drug interactions, malnutrition, vomiting, and liver dysfunction in these patients. Moreover, cancer patients are at an increased risk of adverse effects of warfarin therapy. In contrast, low-molecular-weight heparins (LMWHs) are associated with a lower risk of adverse events compared with warfarin in patients with cancer. These agents also offer practical advantages compared with warfarin, including more predictable anticoagulant effects and ease of administration in addition to possible antineoplastic effects. Several LMWHs have demonstrated superior efficacy to warfarin in the secondary prevention of VTE. In particular, the LMWH, dalteparin (Fragmin; Pfizer; New York, NY), has recently been shown to have superior efficacy to warfarin in a large trial of patients with cancer and VTE without increasing the risk of bleeding. A randomized trial of dalteparin has also shown improved response rates and survival in patients with small cell lung cancer. In view of the availability of more effective and reliable alternatives to warfarin therapy in cancer patients, it is appropriate to reassess the role of warfarin therapy in patients with cancer and VTE. Further evaluation of the LMWHs for effects on cancer outcome is indicated.     

Cancer-associated thrombosis: focus on extended therapy with dalteparin

The increased risk of thrombosis-related morbidity and mortality in patients with cancer remains, even in the face of anticoagulant therapy. Moreover, recurrent venous thromboembolism (VTE) complicates the management of cancer and adversely affects quality of life and survival. Until recently, initial therapy with unfractionated heparin or low-molecular-weight heparin (LMWH) followed by long-term therapy with an oral anticoagulant was the standard of care for the secondary prevention of acute thromboembolism in most patients. However, according to the results of the CLOT trial (Randomized Comparison of Low-Molecular-Weight Heparin Versus Oral Anticoagulant Therapy for the Prevention of Recurrent VTE in Patients With Cancer), extended LMWH therapy with dalteparin represents an alternative to standard oral anticoagulation. In terms of efficacy, the incidence of recurrent VTE in patients receiving dalteparin was half that of those receiving warfarin (27 of 336 patients vs 53 of 336 patients, respectively), for a 52% relative risk reduction. The incidence of major bleeding in this trial was not significantly different in the two arms. Although this LMWH regimen is supported by the latest practice guidelines of the American College of Chest Physicians, the question of whether long-term treatment with LMWH in cancer patients actually affects survival apart from the benefits of thromboprophylaxis remains to be answered.     

Safety and efficacy of primary thromboprophylaxis in cancer patients

Cancer is often complicated by venous thromboembolism (VTE), a common and potentially fatal complication associated with poor prognosis in these patients. An increased incidence of VTE is being observed due to the advanced age of cancer patients, the thrombogenic effect of novel drugs and advances in the diagnosis of related complications. In this review, we look at five different risk groups of cancer patients with an increased probability of developing VTE, including hospitalized patients undergoing chemotherapy, patients undergoing a surgical procedure, ambulatory patients undergoing chemotherapy, patients with a central venous access and patients receiving antiangiogenic drugs or anticoagulant therapy due to previous chronic diseases. The aim of this review is to summarize the most important clinical evidence reported to date on the suitability of primary thromboprophylaxis to cancer patients. Recommendations have drawn up for each group based on current evidence and guidelines to facilitate decision-making in clinical practice.     

Prophylactic and therapeutic anticoagulation for thrombosis: major issues in oncology

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with cancer. Primary prevention with pharmacologic agents (or mechanical methods, if anticoagulants are contraindicated) is recommended in all cancer patients hospitalized for surgical or medical reasons. The role of prophylaxis in outpatients is less certain because of the diversity of the patient populations and their cancer treatments with respect to the associated risks of VTE and bleeding. Treatment with low-molecular weight heparin is the recommended first-line approach in cancer patients with newly diagnosed VTE, and is usually continued for a minimum of 3-6 months. Other management issues that require further research include the optimum duration of anticoagulant therapy, the treatment of recurrent VTE, the role of vena cava filters, the effects of VTE and its treatment on quality of life, and the impact of anticoagulants on survival. Newer anticoagulants hold promise in providing more-effective and convenient treatment of VTE in this high-risk population, but further studies are awaited.     

宫颈癌合并深静脉血栓30例临床分析

目的:静脉血栓栓塞症(VTE)是恶性肿瘤患者常见并发症。本文结合文献分析我院住院病人宫颈癌患者静脉血栓的临床特征,分析VTE形成机制及诱发因素,探索最佳治疗方法。方法:对近5年我科收治的宫颈癌合并深静脉血栓30例患者的临床资料进行分析。结果:30例患者中17例VTE的发生和介入手术化疗有关。2例(6.7%)血栓栓塞发生在宫颈癌确诊之前,28例(93.3%)发生在宫颈癌确诊之后,单纯并发下肢深静脉血栓形成(DVT)27例,合并肺栓塞(PTE)2例,DVT合并PTE 1例。22例在栓塞前有化疗史。结论:血栓可能为肿瘤病人的首发表现,病人出现不能解释的血栓栓塞性疾病应考虑有肿瘤的可能。抗凝治疗对于血栓栓塞症疗效确切。及时诊断和治疗可以延长患者的生存期,降低患者的死亡率。口服避孕药、口服甲地孕酮、介入手术与VTE的发生几率可能有关。分期晚,远地转移的肿瘤患者易出现血栓栓塞。