Departments of Medicine and Pathology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205, USA.
J Thromb Thrombolysis. 2011 Apr;31(3):282-94. doi: 10.1007/s11239-011-0562-0.
Cancer is associated with a four to sevenfold increased risk of venous thromboembolism (VTE). This risk is influenced by the site and extent of cancer and its treatment. Despite its availability, effective VTE prophylaxis is used in less than 50% of oncology patients. Pharmacologic VTE prophylaxis should be administered to all hospitalized medical and surgical oncology patients for the duration of their hospitalization or up to 10-14 days, whichever is longer. Extended duration (up to 4 weeks post-operation) VTE prophylaxis is recommended for high-risk surgical oncology patients. Routine use of prophylaxis in ambulatory medical oncology patients awaits prospective testing of VTE risk assessment models. Routine prophylactic dose anticoagulation to prevent central venous catheter (CVC) thrombosis is ineffective and not indicated. Low molecular weight heparin is the first line choice for acute and chronic therapy of VTE in cancer patients. Therapy should continue for at least 3 months or the duration of the malignancy, whichever is longer. Anticoagulation is indicated for at least 3 months or the duration of the catheter for CVC thrombosis. Preliminary data indicate that some cancer patients with pulmonary embolism may be managed as outpatients. Prospective validation of these studies and testing of current risk assessment strategies in oncology patients is warranted. Management of recurrent VTE and unsuspected VTE in the cancer patient are also reviewed.
癌症与静脉血栓栓塞症（VTE）的风险增加 4 至 7 倍相关。这种风险受癌症部位和范围及其治疗的影响。尽管有这种方法，但有效的 VTE 预防措施在不到 50%的肿瘤患者中使用。应在所有住院的内科和外科肿瘤患者住院期间或最长 10-14 天内使用药物性 VTE 预防措施。对于高危外科肿瘤患者，建议延长（术后 4 周内）VTE 预防措施。在门诊内科肿瘤患者中常规使用预防措施，需要对 VTE 风险评估模型进行前瞻性测试。常规预防性抗凝预防中心静脉导管（CVC）血栓形成是无效且不推荐的。低分子肝素是癌症患者 VTE 急性和慢性治疗的首选。治疗应至少持续 3 个月或癌症持续时间，以较长者为准。抗凝治疗应至少持续 3 个月或 CVC 血栓形成的导管持续时间。初步数据表明，一些患有肺栓塞的癌症患者可能可以作为门诊患者进行管理。需要前瞻性验证这些研究，并在肿瘤患者中测试当前的风险评估策略。还审查了癌症患者复发性 VTE 和未发现的 VTE 的管理。
