Yap Karen P L, McCready David R
Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada.
Asian J Surg. 2004 Jul;27(3):249-54. doi: 10.1016/S1015-9584(09)60045-2.
Oncology patients are at increased risk of developing deep vein thrombosis (DVT) and its potentially fatal sequel, pulmonary embolism. This is due to multiple factors, including the presence of the malignancy itself, comorbid factors and therapy-related interventions. Issues that are peculiar to venous thrombosis in the oncology setting are discussed, based on a MEDLINE search of the English literature. These include the need to screen for malignancy in idiopathic DVT, a high index of suspicion for venous thrombosis in the cancer patient, the use of vena cava filters, and the anti-neoplastic effects of heparin. Asian patients appear to have a lower incidence of DVT compared to Caucasians. A recommended regimen for prophylaxis of DVT must take into account the varying thrombosis risk associated with different malignancies. Cancer patients not undergoing abdominal, pelvic or orthopaedic surgery (e.g. mastectomy) should use elastic compression stockings and be mobilized early, whereas low-molecular-weight heparin should be given to those undergoing more major surgery. In advanced malignancy, treatment of DVT palliates symptoms. These patients may need long-term anticoagulation with warfarin.
肿瘤患者发生深静脉血栓形成（DVT）及其潜在致命后果——肺栓塞的风险增加。这是由多种因素导致的，包括恶性肿瘤本身的存在、合并症因素以及与治疗相关的干预措施。基于对英文文献的MEDLINE检索，讨论了肿瘤患者静脉血栓形成所特有的问题。这些问题包括在特发性DVT中筛查恶性肿瘤的必要性、对癌症患者静脉血栓形成的高度怀疑指数、腔静脉滤器的使用以及肝素的抗肿瘤作用。与白种人相比，亚洲患者DVT的发病率似乎较低。推荐的DVT预防方案必须考虑到与不同恶性肿瘤相关的不同血栓形成风险。未接受腹部、盆腔或骨科手术（如乳房切除术）的癌症患者应使用弹性压缩袜并尽早活动，而对于接受更大型手术的患者应给予低分子量肝素。在晚期恶性肿瘤中，DVT的治疗可缓解症状。这些患者可能需要使用华法林进行长期抗凝治疗。
