Centro de Oncologia, Hospital Sirio Libanês, São Paulo, SP, Brazil.
J Thromb Thrombolysis. 2010 Jul;30(1):67-78. doi: 10.1007/s11239-010-0441-0.
Venous thromboembolism (VTE) is a serious and potentially fatal disorder, which is often associated with a significant impact on the quality of life and on the clinical outcome of cancer patients. The pathophysiology of the association between thrombosis and cancer is complex: malignancy is associated with a baseline hypercoagulable state due to many factors including release of inflammatory cytokines, activation of the clotting system, expression of hemostatic proteins on tumor cells, inhibition of natural anticoagulants, and impaired fibrinolysis. Several risk factors, related to the patient, the disease, and the therapeutic interventions, have been identified as contributing to the occurrence of VTE. There is convincing evidence to recommend the use of heparins or fondaparinux for prevention of VTE in selected cancer patients, and, especially in some particular types of malignancies and cancer treatments. Management of VTE in patients with cancer is more challenging and bleeding complications associated with the use of anticoagulants are significantly higher in cancer patients than in those without malignancy. Important issues that need to be considered in all cases are interference with anticancer therapy, inconvenience of treatment, and impact on quality of life.
静脉血栓栓塞症（VTE）是一种严重且潜在致命的疾病，常与癌症患者的生活质量和临床结局显著相关。血栓形成与癌症之间的病理生理学关联较为复杂：由于多种因素，包括炎症细胞因子的释放、凝血系统的激活、肿瘤细胞表达止血蛋白、天然抗凝剂的抑制以及纤维蛋白溶解受损等，恶性肿瘤患者存在基础高凝状态。已经确定了一些与患者、疾病和治疗干预相关的危险因素，这些因素可导致 VTE 的发生。有令人信服的证据表明，建议在某些选定的癌症患者中使用肝素或磺达肝癸钠来预防 VTE，特别是在某些特定类型的恶性肿瘤和癌症治疗中。癌症患者的 VTE 管理更具挑战性，且出血并发症的发生率显著高于非恶性肿瘤患者。在所有情况下都需要考虑的重要问题是对癌症治疗的干扰、治疗的不便以及对生活质量的影响。
