Lee Agnes Y Y
Department of Medicine, McGill University, Hamilton, ON L8V 1C3, Canada.
Expert Opin Pharmacother. 2003 Dec;4(12):2213-20. doi: 10.1517/14656566.4.12.2213.
Primary and secondary prevention of venous thromboembolism (VTE) are the major roles of anti-thrombotic therapy in patients with cancer. Although the choices of pharmacological agents remain limited, low molecular weight heparins (LMWHs) offer important advantages over traditional anticoagulants. For prophylaxis in the surgical setting, once-daily subcutaneous injections of LMWH are as effective and safe as multiple doses of unfractionated heparin and extending prophylaxis with LMWH beyond hospitalisation can safely reduce the risk of postoperative thrombosis after abdominal surgery for cancer. For treatment and secondary prophylaxis, clinical trials have shown that LMWHs are feasible, safe and more effective than oral anticoagulants in preventing recurrent VTE in cancer patients. Nonetheless, formal economic analyses are needed to study the cost-effectiveness of these agents. The preliminary observations that LMWHs are associated with reduction in cancer mortality make these agents an attractive therapeutic option in oncology patients.
静脉血栓栓塞症（VTE）的一级和二级预防是抗血栓治疗在癌症患者中的主要作用。尽管药物治疗的选择仍然有限，但低分子量肝素（LMWHs）相对于传统抗凝剂具有重要优势。在外科手术环境中进行预防时，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，并且在住院后继续使用低分子量肝素进行预防可以安全地降低癌症腹部手术后的术后血栓形成风险。对于治疗和二级预防，临床试验表明，在预防癌症患者复发性VTE方面，低分子量肝素是可行、安全且比口服抗凝剂更有效的。尽管如此，仍需要进行正式的经济分析来研究这些药物的成本效益。低分子量肝素与癌症死亡率降低相关的初步观察结果使这些药物成为肿瘤患者有吸引力的治疗选择。
