Cunningham M S, White B, Hollywood D, O'Donnell J
Department of Haematology, Institute of Molecular Medicine, St. James's Hospital and Trinity College, Dublin, Ireland.
Br J Cancer. 2006 Jan 30;94(2):189-94. doi: 10.1038/sj.bjc.6602917.
Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis.
在英国医院的实际诊疗中，静脉血栓栓塞症（VTE）每年导致约25000人死亡。众所周知，通过使用适当的血栓预防措施，许多此类死亡是可以避免的。这个问题在肿瘤学诊疗中尤为重要，因为VTE和出血的风险在肿瘤患者中都显著高于普通内科患者。留置中心静脉导管（CVC）的癌症患者发生血栓并发症的风险尤其高。然而，关于在这些患者中使用常规一级血栓预防措施的疗效，文献得出了相互矛盾的结论。事实上，围绕这个话题的混乱程度如此之高，以至于美国胸科医师学会（ACCP）2004年发布的最新版指南实际上推翻了其先前（2001年发布）的建议。尽管如此，小剂量华法林在英国的许多肿瘤中心仍被常规使用。在本文中，我们对已发表的有关在留置CVC的癌症患者中使用血栓预防措施（小剂量华法林或低剂量低分子肝素）的疗效和风险的文献进行了系统综述。基于这些证据，我们得出结论，使用此类血栓预防措施并无经证实的作用。然而，无症状的CVC相关静脉血栓仍然很常见，因此需要进一步开展设计更优、样本量更大的研究，以确定癌症患者的特定亚组是否可能从接受血栓预防措施中获益。
