Viale Pamela Hallquist, Schwartz Rowena N
Clin J Oncol Nurs. 2004 Oct;8(5):465-9. doi: 10.1188/04.CJON.465-469.
Patients with cancer have an increased risk of thromboembolism. This complication is connected to a variety of different factors and is influenced by the conditions described in Virchow's triad: stasis, vascular endothelial damage, and hypercoagulability. Once thromboembolism is diagnosed, treatment in patients with cancer usually involves anticoagulation with unfractionated or low-molecular-weight heparin and progression to oral anticoagulant therapy. Duration of treatment is usually three to six months, with most patients receiving six months of anticoagulation. Patients with cancer may be at risk for recurrent thrombosis as well, despite optimal use of oral anticoagulant therapy, and some of these patients may require lifelong heparin therapy. This article describes the current treatment regimens to provide anticoagulation therapy to patients with cancer, including a discussion of the low-molecular-weight heparins and dosing parameters. Nursing interventions to help provide these treatments safely are discussed. Patients with cancer have a high rate of thromboembolism; oncology nurses should heighten their awareness of this important complication, treatment options, and appropriate nursing interventions.
癌症患者发生血栓栓塞的风险增加。这种并发症与多种不同因素相关，并受维勒氏三联征所描述的情况影响：血流淤滞、血管内皮损伤和高凝状态。一旦诊断出血栓栓塞，癌症患者的治疗通常包括使用普通肝素或低分子肝素进行抗凝，并过渡到口服抗凝治疗。治疗持续时间通常为三到六个月，大多数患者接受六个月的抗凝治疗。尽管最佳使用口服抗凝治疗，癌症患者仍可能有复发性血栓形成的风险，其中一些患者可能需要终身肝素治疗。本文介绍了目前为癌症患者提供抗凝治疗的方案，包括对低分子肝素和给药参数的讨论。还讨论了有助于安全提供这些治疗的护理干预措施。癌症患者血栓栓塞发生率很高；肿瘤学护士应提高对这一重要并发症、治疗选择和适当护理干预措施的认识。
