Prandoni Paolo, Falanga Anna, Piccioli Andrea
Department of Medical and Surgical Sciences, Second Chair of Internal Medicine, University of Padua, Padua, Italy.
Lancet Oncol. 2005 Jun;6(6):401-10. doi: 10.1016/S1470-2045(05)70207-2.
Venous thromboembolism occurs commonly in patients with cancer. The pathogenetic mechanisms of thrombosis involve a complex interaction between tumour cells, the haemostatic system, and characteristics of the patient. Among risk factors for thromboembolism are long-term immobilisation, especially in hospital, surgery, and chemotherapy with or without adjuvant hormone therapy. Although prophylaxis and treatment of thromboembolism in patients with cancer draw on the agents that are commonly used in those without cancer, there are many special features of patients with cancer that make use of these drugs more challenging. Low-molecular-weight heparins are the cornerstone of prophylaxis and treatment of venous thromboembolism in patients with cancer. These drugs have the potential to increase survival, at least in patients with more favourable outlook. About 10% of patients with idiopathic venous thromboembolism have an underlying malignant disorder that can be detected by extensive diagnostic investigation. However, the issue of whether screening for occult malignant disease ultimately improves prognosis and survival remains to be resolved.
静脉血栓栓塞在癌症患者中很常见。血栓形成的发病机制涉及肿瘤细胞、止血系统和患者特征之间的复杂相互作用。血栓栓塞的危险因素包括长期制动，尤其是在医院、手术以及接受化疗（无论是否联合辅助激素治疗）。尽管癌症患者血栓栓塞的预防和治疗借鉴了非癌症患者常用的药物，但癌症患者有许多特殊情况，使得这些药物的使用更具挑战性。低分子量肝素是癌症患者静脉血栓栓塞预防和治疗的基石。这些药物有可能提高生存率，至少在预后较好的患者中如此。约10%的特发性静脉血栓栓塞患者存在潜在的恶性疾病，可通过广泛的诊断性检查检测出来。然而，隐匿性恶性疾病筛查最终是否能改善预后和生存率这一问题仍有待解决。
