Nishioka Jennifer, Goodin Susan
The Cancer Institute of New Jersey, UMDNJ Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, New Jersey 08901, US.
J Oncol Pharm Pract. 2007 Jun;13(2):85-97. doi: 10.1177/1078155207079169.
Venous thromboembolism (VTE) occurs more frequently in cancer patients than in non-cancer patients and outcomes are poor in patients with both cancer and thrombosis. Patients with cancer who develop thrombosis are more likely to experience a recurrence of VTE and have increased bleeding complications while receiving oral anticoagulant treatment. The purpose of this paper is to discuss the causes and outcomes of thrombosis in cancer patients, the limitations of warfarin therapy, the guidelines and data for the use of low-molecular-weight heparins (LMWHs) in the treatment and secondary prevention of thrombosis in cancer patients, and emerging data regarding survival with the use of LMWH in cancer patients.
Literature for this paper has been collected using multiple sources, including primary, secondary, and tertiary references. Online searches have been conducted utilizing the PubMed and OVID databases, and abstracts from the Proceedings of the American Society of Clinical Oncology and the American Society of Hematology Annual Meeting and Exhibition. The following key terms were used in the search: cancer, deep vein thrombosis, pulmonary embolism, anticoagulation, LMWHs, guidelines, survival, cost.
The long-term use of LMWHs in the settings of cancer and thrombosis are supported by recent clinical trial evidence that demonstrate their equivalent safety and improved efficacy when compared to oral anticoagulants resulting in their inclusion in current guidelines. Finally, newer studies offer further evidence of improved outcomes with dalteparin and nadroparin, including possible survival benefits.
Treatment with LMWHs has been shown to be more effective than warfarin in the extended treatment of VTE in patients with cancer and is safe in this setting. Use of a LMWH for at least the first 3-6 months of long-term treatment is now considered the standard of care for patients with cancer and is recommended in numerous guidelines. Additionally, further evaluation of the survival benefits of LMWH in cancer patients is warranted.
静脉血栓栓塞症（VTE）在癌症患者中比在非癌症患者中更频繁发生，并且癌症和血栓形成患者的预后较差。发生血栓形成的癌症患者在接受口服抗凝治疗时更有可能发生VTE复发，且出血并发症增加。本文旨在讨论癌症患者血栓形成的原因和预后、华法林治疗的局限性、低分子量肝素（LMWHs）在癌症患者血栓形成治疗和二级预防中的使用指南及数据，以及使用LMWH对癌症患者生存影响的新数据。
本文的文献收集使用了多种来源，包括一级、二级和三级参考文献。利用PubMed和OVID数据库进行了在线搜索，并检索了美国临床肿瘤学会会议记录以及美国血液学会年会和展览的摘要。搜索中使用了以下关键词：癌症、深静脉血栓形成、肺栓塞、抗凝、LMWHs、指南、生存、成本。
近期临床试验证据支持在癌症和血栓形成情况下长期使用LMWHs，这些证据表明与口服抗凝剂相比，LMWHs具有同等安全性且疗效更佳，因此被纳入当前指南。最后，更新的研究提供了进一步证据，证明达肝素和那屈肝素能改善预后，包括可能的生存获益。
已证明LMWHs治疗在癌症患者VTE的延长治疗中比华法林更有效，且在此情况下是安全的。现在认为对癌症患者进行至少前3 - 6个月的长期治疗使用LMWH是标准治疗方案，并且在众多指南中均有推荐。此外，有必要进一步评估LMWH对癌症患者生存的益处。
