Thrombosis Program, Vancouver Coastal Health Vancouver General Hospital, and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Hematology Am Soc Hematol Educ Program. 2010;2010:144-9. doi: 10.1182/asheducation-2010.1.144.
Thromboembolism is a common, complex, and costly complication in patients with cancer. Management has changed significantly in the past decade, but remains firmly dependent on the use of anticoagulants. Low-molecular-weight heparin is the preferred anticoagulant for prevention and treatment, although its limitations open opportunities for newer oral antithrombotic agents to further simplify therapy. Multiple clinical questions remain, and research is focusing on identifying high-risk patients who might benefit from primary thromboprophylaxis, treatment options for those with established or recurrent thrombosis, and the potential antineoplastic effects of anticoagulants. Risk-assessment models, targeted prophylaxis, anticoagulant dose escalation for treatment, and ongoing research studying the interaction of coagulation activation in malignancy may offer improved outcomes for oncology patients.
血栓栓塞是癌症患者中常见、复杂且代价高昂的并发症。在过去十年中,其管理发生了重大变化,但仍然严重依赖于抗凝剂的使用。低分子量肝素是预防和治疗的首选抗凝剂,尽管其局限性为新型口服抗血栓药物提供了进一步简化治疗的机会。仍存在多个临床问题,研究重点是确定可能从初级血栓预防中获益的高危患者、有或无复发性血栓形成的治疗选择,以及抗凝剂的潜在抗肿瘤作用。风险评估模型、靶向预防、抗凝剂治疗剂量升级以及正在研究恶性肿瘤中凝血激活相互作用的研究,可能为肿瘤患者提供更好的治疗效果。