Cunningham Regina S
The Cancer Institute of New Jersey; and the University of Medicine & Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
Semin Oncol. 2006 Apr;33(2 Suppl 4):S17-25; quiz S41-2. doi: 10.1053/j.seminoncol.2006.01.022.
Venous thromboembolism (VTE) is a common complication of malignant disease, affecting approximately 1 in 200 cancer patients. Oncology nurses are instrumental in identifying patients with cancer at high risk of venous thromboembolism. Risk factors include: stage of disease, chemotherapy, the patient's degree of immobility, a history of recent surgery, and the presence of a central venous catheter. The treatment of venous thromboembolism in patients with cancer usually involves a sequential combination of unfractionated heparin or low-molecular-weight heparin (LMWH), followed by oral warfarin or LMWH. LMWHs are an alternative to warfarin for secondary prophylaxis and long-term treatment. LMWH is given by subcutaneous injection, does not require hospitalization for administration or routine laboratory monitoring. Recent clinical trial results have shown that LMWH use is associated with improved survival in cancer patients with relatively good prognoses. Patients receiving any anticoagulant therapy should be monitored for signs of pulmonary embolism or bleeding and intravenous sites (if present) should be monitored for oozing. Appropriate patient selection, a carefully constructed treatment plan, extensive patient education, and regular patient contact are integral elements for the nursing care of patients with cancer-associated thrombosis treated in the outpatient setting.
静脉血栓栓塞症（VTE）是恶性疾病的常见并发症，约每200名癌症患者中就有1人受其影响。肿瘤专科护士在识别有静脉血栓栓塞症高风险的癌症患者方面发挥着重要作用。风险因素包括：疾病分期、化疗、患者的活动受限程度、近期手术史以及中心静脉导管的存在。癌症患者静脉血栓栓塞症的治疗通常包括普通肝素或低分子肝素（LMWH）的序贯联合使用，随后使用口服华法林或LMWH。LMWH是华法林用于二级预防和长期治疗的替代药物。LMWH通过皮下注射给药，给药时无需住院或进行常规实验室监测。最近的临床试验结果表明，在预后相对较好的癌症患者中使用LMWH与生存率提高相关。接受任何抗凝治疗的患者都应监测肺栓塞或出血的迹象，对于静脉穿刺部位（如有）应监测有无渗血。合适的患者选择、精心制定的治疗计划、广泛的患者教育以及定期的患者联系是门诊治疗癌症相关血栓形成患者护理工作的重要组成部分。
