Lee Agnes Y Y
Department of Medicine, McMaster University Hamilton, Ontario, Canada.
Thromb Res. 2007;120 Suppl 2:S121-7. doi: 10.1016/S0049-3848(07)70140-8.
Monotherapy with low molecular weight heparin (LMWH) is superior to vitamin K antagonists in preventing recurrent venous thromboembolism (VTE) in patients with cancer and may improve the survival of patients with less advanced malignancies. These agents are also the preferred anticoagulants for primary prophylaxis in medical and surgical patients in hospital. Despite their limitations, LMWHs have improved the quality of care and quality of life in patients with VTE. Recent research has also explored the role of LMWH as anticancer agents. Evidence from experimental studies have demonstrated inhibitory effects of LMWH on various processes that are necessary for tumour growth and progression while results from clinical trials have shown a reduction in overall mortality in patients treated with LMWH. However, because of limitations and differences in study designs as well as small sample sizes, it remains uncertain whether the reduction in mortality is real and whether LMWH achieve this effect through inhibition of coagulation, non-anticoagulant mechanisms or both. Multiple anticancer mechanisms, including inhibition of tumour angiogenesis, interference with tumour cell adhesion, and suppression of tumour cell invasion, have been demonstrated in experimental models with LMWH, but none have been confirmed in vivo in humans. This review will briefly summarize the data on the treatment of VTE in cancer patients with LMWH and discuss the experimental and clinical data on its possible anticancer effects.
在预防癌症患者复发性静脉血栓栓塞（VTE）方面，低分子量肝素（LMWH）单药治疗优于维生素K拮抗剂，并且可能改善病情较轻的恶性肿瘤患者的生存率。这些药物也是医院内科和外科患者一级预防的首选抗凝剂。尽管存在局限性，但低分子量肝素已改善了VTE患者的护理质量和生活质量。最近的研究还探讨了低分子量肝素作为抗癌药物的作用。实验研究的证据表明，低分子量肝素对肿瘤生长和进展所必需的各种过程具有抑制作用，而临床试验的结果显示，接受低分子量肝素治疗的患者的总死亡率有所降低。然而，由于研究设计的局限性和差异以及样本量较小，死亡率的降低是否真实以及低分子量肝素是否通过抑制凝血、非抗凝机制或两者来实现这一效果仍不确定。在低分子量肝素的实验模型中已证实多种抗癌机制，包括抑制肿瘤血管生成、干扰肿瘤细胞黏附以及抑制肿瘤细胞侵袭，但在人体体内均未得到证实。本综述将简要总结低分子量肝素治疗癌症患者VTE的数据，并讨论其可能的抗癌作用的实验和临床数据。
