Gerotziafas Grigoris T, Papageorgiou Chryssoula, Hatmi Mohamed, Samama Meyer-Michel, Elalamy Ismail
EA3499, Faculty of Medicine, University Pierre and Marie Curie (Paris VI), Paris, France.
Pathophysiol Haemost Thromb. 2008;36(3-4):204-11. doi: 10.1159/000175158. Epub 2009 Jan 27.
Cancer is linked with hypercoagulability and risk of thrombosis and this close association was recognized by Armand Trousseau in 1865. The relation between cancer and blood coagulation is reciprocal: cancer induces a hypercoagulable state and predisposes to thrombosis and activation of platelets, blood coagulation and fibrinolysis interfere with tumor cell biology, tumor growth, angiogenesis and metastatic process. In the present article, we analyze the clinical trials which assessed the influence of anticoagulant treatment on the survival of patients with cancer. The available data show that low-molecular-weight heparins (LMWHs) tend to be more effective and safer than vitamin K antagonists (VKA) in improving survival in patients with cancer. The beneficial effect of anticoagulation with either LMWHs or VKA is not universal for all patients with cancer. There are some histological types of cancers which, at early stages, appear to be more sensitive than others to the effect of anticoagulant treatment. The available clinical trials, although limited, are encouraging for the beneficial effect of anticoagulant treatment on the survival of cancer patients. More clinical trials are needed, targeting groups of patients homogenous regarding the type of cancer, the stage of the disease and life expectancy. The forthcoming clinical trials have to address some issues regarding the optimal dose, the timing and the duration of treatment with LMWH in relation to chemotherapy or other anticancer therapies.
癌症与高凝状态及血栓形成风险相关，这种密切关联在1865年被阿尔芒·特鲁索认识到。癌症与血液凝固之间的关系是相互的：癌症诱发高凝状态并易导致血栓形成以及血小板激活，血液凝固和纤维蛋白溶解会干扰肿瘤细胞生物学、肿瘤生长、血管生成和转移过程。在本文中，我们分析了评估抗凝治疗对癌症患者生存影响的临床试验。现有数据表明，在改善癌症患者生存方面，低分子肝素（LMWHs）往往比维生素K拮抗剂（VKA）更有效且更安全。使用LMWHs或VKA进行抗凝的有益效果并非对所有癌症患者都普遍适用。有些组织学类型的癌症在早期似乎比其他类型对抗凝治疗的效果更敏感。现有临床试验虽然有限，但对抗凝治疗对癌症患者生存的有益效果是令人鼓舞的。需要更多针对癌症类型、疾病阶段和预期寿命相同的患者群体的临床试验。即将开展的临床试验必须解决一些关于LMWH与化疗或其他抗癌疗法相关的最佳剂量、治疗时机和持续时间的问题。
