Love R R, Surawicz T S, Williams E C
Cancer Prevention Program, University of Wisconsin Clinical Cancer Center, Madison.
Arch Intern Med. 1992 Feb;152(2):317-20.
Adjuvant therapy for breast cancer with tamoxifen is suggested to be of benefit to both women with negative and women with positive axillary nodes, and treatment lasting several years is currently being investigated. Venous thrombophlebitis may complicate tamoxifen treatment at a rate of approximately one per 800 treatment-years. To explore the possible mechanisms of this effect, we evaluated changes in antithrombin III levels, fibrinogen levels, and platelet counts in 140 postmenopausal women with surgically resected breast cancer who were disease free and participating in a double-blind, placebo-controlled, randomized toxicity study of tamoxifen. Antithrombin III levels, elevated at baseline evaluation, decreased in tamoxifen-treated subjects at 6 months, but no subject exhibited a drop to clinically significant levels. Fibrinogen levels decreased 15% (0.4 g/L) in tamoxifen-treated subjects at 6 months. Platelet counts decreased 7% to 9% from baseline to evaluations at 3, 6, 12, 18, and 24 months in tamoxifen-treated subjects. While these changes do not explain the possible small thrombophlebitis-promoting effect of tamoxifen, the decrease in fibrinogen levels might be expected to be associated with a decreased risk of arterial thrombosis.
他莫昔芬辅助治疗乳腺癌对腋窝淋巴结阴性和阳性的女性均有益，目前正在研究持续数年的治疗方法。静脉血栓性静脉炎可能使他莫昔芬治疗复杂化，发生率约为每800治疗年1例。为了探究这种效应的可能机制，我们评估了140例绝经后接受手术切除且无疾病的乳腺癌女性的抗凝血酶III水平、纤维蛋白原水平和血小板计数变化，这些女性参与了一项关于他莫昔芬的双盲、安慰剂对照、随机毒性研究。抗凝血酶III水平在基线评估时升高，在接受他莫昔芬治疗的受试者中6个月时下降，但没有受试者降至临床显著水平。接受他莫昔芬治疗的受试者在6个月时纤维蛋白原水平下降了15%（0.4 g/L）。从基线到3、6、12、18和24个月评估时，接受他莫昔芬治疗的受试者血小板计数下降了7%至9%。虽然这些变化无法解释他莫昔芬可能存在的轻微促血栓性静脉炎效应，但纤维蛋白原水平的下降可能会降低动脉血栓形成的风险。
