Pruemer Jane
University of Cincinnati College of Pharmacy, University Hospital and Barrett Cancer Center, 234 Goodman Street, ML 0740, Cincinnati, OH 45219-2316, USA.
Am J Health Syst Pharm. 2005 Nov 15;62(22 Suppl 5):S4-6. doi: 10.2146/ajhp050431.
Despite advances in the treatment of venous thromboembolism (VTE) in the cancer population, cancer-associated thrombosis remains a serious and potentially life-threatening disease. This article will review the scope and impact of cancer-associated thrombosis, some of the possible risk factors, and current practice patterns.
Epidemiology data identify thrombosis as the second leading cause of mortality in cancer patients following the disease itself. The risk of recurrent VTE and all-cause death is 3-fold higher in patients with concurrent VTE and malignancy compared to non-cancer patients with VTE. It has been estimated that one in seven hospitalized cancer patients who die do so from a pulmonary embolism. Risk factors for cancer-associated thrombosis include tumor type, anti-tumor therapy, surgery, and immobility. Furthermore, an idiopathic VTE can be a predictor of occult malignancy, with one study suggesting that individuals who present with an unprovoked episode of VTE have a 10% frequency of subsequent cancer. The Fundamental Research in Oncology and Thrombosis (FRONTLINE) study collected data on the perceived risks and practice patterns with regard to VTE in cancer patients undergoing surgical and medical management of their malignancy. Additionally, the study provided information on international and regional practice patterns for the management of VTE in cancer patients. Respondents indicated that brain and pancreatic tumors were associated with an increased risk of VTE. Eight percent of respondents considered the use of central venous access lines to be associated with a high risk of VTE. The FRONTLINE study also indicated that surgeons are more likely to use thromboprophylaxis than medical oncologists and that low molecular weight heparins (LMWHs) are the most commonly used method for prevention of VTE.
Cancer patients are at greater risk of VTE and death compared to non-cancer patients; therefore, optimizing methods for the treatment and prevention of thrombosis is of particular importance in this population.
尽管癌症患者静脉血栓栓塞症（VTE）的治疗取得了进展，但癌症相关血栓形成仍然是一种严重且可能危及生命的疾病。本文将综述癌症相关血栓形成的范围和影响、一些可能的危险因素以及当前的实践模式。
流行病学数据表明，血栓形成是癌症患者继疾病本身之后的第二大死亡原因。与非癌症VTE患者相比，同时患有VTE和恶性肿瘤的患者复发性VTE和全因死亡风险高出3倍。据估计，每七名住院癌症死亡患者中就有一名死于肺栓塞。癌症相关血栓形成的危险因素包括肿瘤类型、抗肿瘤治疗、手术和活动减少。此外，特发性VTE可能是隐匿性恶性肿瘤的一个预测指标，一项研究表明，出现无诱因VTE发作的个体后续患癌频率为10%。肿瘤学与血栓形成基础研究（FRONTLINE）收集了接受恶性肿瘤手术和药物治疗的癌症患者对VTE的感知风险和实践模式的数据。此外，该研究还提供了癌症患者VTE管理的国际和地区实践模式信息。受访者表示，脑肿瘤和胰腺肿瘤与VTE风险增加有关。8%的受访者认为使用中心静脉通路与VTE高风险有关。FRONTLINE研究还表明，外科医生比肿瘤内科医生更有可能使用血栓预防措施，低分子量肝素（LMWHs）是预防VTE最常用的方法。
与非癌症患者相比，癌症患者发生VTE和死亡的风险更高；因此，优化血栓形成的治疗和预防方法在这一人群中尤为重要。
