Lee Agnes Y Y
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Curr Opin Pulm Med. 2003 Sep;9(5):351-5. doi: 10.1097/00063198-200309000-00002.
Accumulating evidence suggests that low-molecular-weight heparins are the drug of choice for the prevention and treatment of venous thromboembolism in patients with cancer. For prophylaxis in the surgical setting, once-daily subcutaneous injections of low-molecular-weight heparin are as effective and safe as multiple doses of unfractionated heparin. Extending prophylaxis with low-molecular-weight heparins beyond hospitalization was recently found to reduce safely the risk of postoperative thrombosis after abdominal surgery for cancer. For the long-term treatment of deep vein thrombosis and in select patients with pulmonary embolism, recently completed clinical trials have shown that secondary prophylaxis with low-molecular-weight heparin is feasible and more effective than oral anticoagulant therapy in preventing recurrent venous thromboembolism in cancer patients. There is also evidence that low-molecular-weight heparins are effective in cancer patients who develop recurrent thrombosis while on warfarin therapy. Lastly, the potential antineoplastic effects of low-molecular-weight heparins make these agents an attractive option in patients with cancer. Although the management of cancer patients with venous thromboembolism remains challenging, low-molecular-weight heparins have simplified and improved the prevention and treatment of venous thromboembolism in these high-risk patients.
越来越多的证据表明，低分子量肝素是预防和治疗癌症患者静脉血栓栓塞的首选药物。在外科手术中进行预防时，每日一次皮下注射低分子量肝素与多次注射普通肝素一样有效且安全。最近发现，在住院后继续使用低分子量肝素进行预防可安全降低癌症腹部手术后的血栓形成风险。对于深静脉血栓形成的长期治疗以及部分肺栓塞患者，最近完成的临床试验表明，在预防癌症患者复发性静脉血栓栓塞方面，使用低分子量肝素进行二级预防是可行的，且比口服抗凝治疗更有效。也有证据表明，低分子量肝素对在接受华法林治疗时发生复发性血栓形成的癌症患者有效。最后，低分子量肝素潜在的抗肿瘤作用使这些药物成为癌症患者的一个有吸引力的选择。尽管癌症合并静脉血栓栓塞患者的管理仍然具有挑战性，但低分子量肝素已简化并改善了这些高危患者静脉血栓栓塞的预防和治疗。
