恶性肿瘤患者与血栓症

血栓症是恶性肿瘤患者的一种常见并发症,直接影响患者的预后。恶性肿瘤可通过多种机制导致血栓形成,而血栓形成又促进了恶性肿瘤的生长和转移。这类血栓症的表现随血栓形成部位的不同而不同,多同时伴有恶性肿瘤的原发表现。90%以上的恶性肿瘤患者可出现凝血系统相关指标异常。恶性肿瘤患者凝血功能正常时,不必进行预防性抗血栓治疗。当凝血功能异常时,预防性治疗的必要性尚无定论,但对于接受手术的恶性肿瘤患者,预防性治疗能显著降低静脉血栓发病率。抗血栓形成药物,如低分子肝素,可控制血液的高凝状态,减少恶性肿瘤患者血栓症的发病率。恶性肿瘤患者一旦确诊有血栓形成就必须进行抗凝治疗,皮下应用低分子肝素已经成为急性血栓症的一线治疗药物。低分子肝素和丙酮苄羟香豆素还可以抑制肿瘤生长和转移,延长肿瘤患者的生存时间。

Cancer patients and thrombosis

Thrombosis is a common complication in cancer patients. These patients will have poor prognoses. Cancer cells can activate blood coagulation through many mechanisms. Furthermore, local thrombosis may speed the growth and metastasis of cancer. Clinical manifestation of thrombosis associated with cancer is different when it occurs in different regions. However, it often complicates with clinical presentation of primary diseases. Laboratory markers of the hypercoagulation state can be found in more than 90% of these patients. There is no need to perform anticoagulation therapy if the patients' coagulant activity is normal. However,when the coagulant activity is abnormal,the necessity of anticoagulation therapy remains to be disputed. But anticoagulation therapy can remarkably reduce the incidence of surgery-associated thrombosis in cancer patients. Antithrombotic drugs such as low-molecular-weight heparin can reduce the incidence of thrombosis. Anticoagulation therapy must start in cancer patients once the diagnosis of thrombosis is made. Low-molecular-weight heparin has become the first line treatment for these patients. Beyond their uses in the prevention and treatment of thrombosis,low-molecular-weight heparins and warfarin can also inhibit angiogenesis,prevent tumor metastasis and prolong survival period in cancer patients.