Institute of Oncology and Radiology of Serbia, Belgrade, Serbia.
J Thromb Thrombolysis. 2010 Aug;30(2):210-4. doi: 10.1007/s11239-010-0438-8.
The data about risk for bleeding complications during anticoagulation in cancer patients with different oncology treatment are conflicting. To investigate the rate of bleeding in the course of oral anticoagulants, during treatment of malignant diseases, we conducted a retrospective study including 75 patients on stable anticoagulation prior to commencing their different oncology treatment. All patients were treated according to the consiliar decision, made based on the localization and pathohistological findings of the malignant disease. During their treatment the regular laboratory monitoring of INR was done. Every dose of oral anticoagulants, INR changes, as well as the size and localization of bleeding were recorded. During all the malignancy treatment 22 (30%) of patients were overanticoagulated. In 15 (20%) patients it was associated with bleeding, while 3 (4%) of them had to be transfused with fresh frozen plasma to stop the major bleeding. Most bleeding complications occurred in the group of patients treated with chemotherapy or with analgesics in the group with advanced disease. None of the bleeding complications were observed in patients treated with irradiation and surgery alone, where the bridging of oral anticoagulants with low molecular weight heparin was done before surgery. The oncology treatment of patients who take oral anticoagulants was connected with high risk for bleeding especially if chemotherapy as a therapeutic options was used. Therefore physicians should be aware of this risk and carefully monitor the intensity of anticoagulant therapy, especially during the first treatment weeks when the risk of bleeding is greatest.
癌症患者在接受不同肿瘤治疗时抗凝出血并发症的风险数据相互矛盾。为了研究口服抗凝剂治疗恶性疾病过程中的出血率，我们进行了一项回顾性研究，纳入了 75 名在开始不同肿瘤治疗前稳定抗凝的患者。所有患者均根据恶性疾病的定位和病理组织学发现，按照顾问的决定进行治疗。在治疗过程中，定期监测 INR 实验室监测。记录每一次口服抗凝剂剂量、INR 变化以及出血的大小和位置。在所有恶性肿瘤治疗期间，22 名（30%）患者出现过度抗凝。其中 15 名（20%）患者与出血相关，其中 3 名（4%）患者需要输注新鲜冷冻血浆以停止大出血。大多数出血并发症发生在接受化疗或晚期疾病组中使用镇痛药的患者中。单独接受放疗和手术治疗的患者中未观察到任何出血并发症，在手术前使用低分子量肝素桥接了口服抗凝剂。接受口服抗凝剂治疗的患者的肿瘤治疗与出血风险高相关，尤其是在使用化疗作为治疗选择时。因此，医生应意识到这种风险，并仔细监测抗凝治疗的强度，尤其是在出血风险最大的最初治疗周期间。
