Connolly Gregory C, Khorana Alok A
James P. Wilmot Cancer Center and the Department of Medicine, University of Rochester, Rochester, NY, USA.
Best Pract Res Clin Haematol. 2009 Mar;22(1):35-47. doi: 10.1016/j.beha.2008.12.006.
The risk of venous thromboembolism (VTE) is elevated in cancer, and thrombosis is the second leading cause of death in patients with malignancy. Many risk factors for cancer-associated thrombosis have been identified. These include patient-associated factors such as age, obesity and medical comorbidities; cancer-associated factors such as site and stage of cancer; and treatment-associated factors, particularly chemotherapy and hospitalization. In addition, several candidate biomarkers for cancer-associated thrombosis have been identified recently. Despite the high rate and significant impact of VTE in cancer outpatients, prior attempts at thromboprophylaxis in this population have not consistently demonstrated a benefit. This chapter will focus on risk stratification approaches, including a recently developed predictive model which can be used to identify those patients at highest risk. This model-based approach may have a significant impact on cancer-related morbidity, mortality and cost of care by directing targeted thromboprophylaxis in the future.
癌症患者发生静脉血栓栓塞（VTE）的风险升高，血栓形成是恶性肿瘤患者的第二大死因。已确定许多与癌症相关血栓形成的危险因素。这些因素包括患者相关因素，如年龄、肥胖和合并症；癌症相关因素，如癌症的部位和分期；以及治疗相关因素，特别是化疗和住院治疗。此外，最近还发现了几种与癌症相关血栓形成的候选生物标志物。尽管VTE在癌症门诊患者中的发生率很高且影响重大，但此前针对该人群进行血栓预防的尝试并未始终证明有获益。本章将重点讨论风险分层方法，包括一种最近开发的预测模型，该模型可用于识别那些风险最高的患者。这种基于模型的方法可能会通过在未来指导有针对性的血栓预防，对癌症相关的发病率、死亡率和护理成本产生重大影响。
