Lee Agnes Y Y
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Thromb Res. 2003 Jun 1;110(4):167-72. doi: 10.1016/s0049-3848(03)00347-5.
Cancer and its treatments are well-recognized risk factors for venous thromboembolism (VTE). Although the incidence of VTE in cancer patients is not well documented, there is evidence that the absolute risk depends on the tumor type, the stage or extent of the cancer, and treatment with antineoplastic agents. The most common cancer types seen in patients with thrombosis are breast, colorectal and lung, reflecting the prevalence of these malignancies in the general population. When the underlying prevalence is taken into account, cancers of the pancreas, ovary and brain are the most strongly associated with thrombotic complications. Although idiopathic thrombosis can be the first manifestation of an occult malignancy, extensive screening for cancer in these patients has not been shown to improve survival and is not warranted. Prophylaxis in patients undergoing major surgery for cancer with either unfractionated or low-molecular-weight heparin (LMWH) is strongly recommended, but prophylaxis in ambulatory medical oncology patients is not routinely indicated. Anticoagulant therapy remains the mainstay treatment of VTE in cancer patients and recent evidence shows that LMWH is effective and well tolerated for both initial therapy and secondary prophylaxis. Despite treatment, cancer patients with thrombosis have a poor prognosis. This is likely due to premature deaths from recurrent VTE and to the aggressive nature of the underlying cancer. Whether LMWH is capable of modifying tumour biology remains unanswered. Further research is needed to address the many clinical questions in the management of thrombosis in patients with cancer.
癌症及其治疗方法是公认的静脉血栓栓塞（VTE）危险因素。虽然癌症患者VTE的发病率尚无充分记录，但有证据表明其绝对风险取决于肿瘤类型、癌症分期或范围以及抗肿瘤药物治疗。血栓形成患者中最常见的癌症类型是乳腺癌、结直肠癌和肺癌，这反映了这些恶性肿瘤在普通人群中的患病率。若考虑基础患病率，胰腺癌、卵巢癌和脑癌与血栓形成并发症的关联最为密切。虽然特发性血栓形成可能是隐匿性恶性肿瘤的首发表现，但对这些患者进行广泛的癌症筛查并未显示能提高生存率，因此并无必要。强烈建议对接受癌症大手术的患者使用普通肝素或低分子肝素（LMWH）进行预防，但对于门诊肿瘤内科患者，通常不建议进行预防。抗凝治疗仍然是癌症患者VTE的主要治疗方法，最近的证据表明，LMWH在初始治疗和二级预防中均有效且耐受性良好。尽管进行了治疗，但血栓形成的癌症患者预后较差。这可能是由于复发性VTE导致的过早死亡以及潜在癌症的侵袭性所致。LMWH是否能够改变肿瘤生物学特性仍未得到解答。需要进一步研究来解决癌症患者血栓形成管理中的许多临床问题。
