Meyer G, Belmont L
Service de pneumologie-soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, faculté de médecine, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
Rev Mal Respir. 2011 Apr;28(4):443-52. doi: 10.1016/j.rmr.2011.02.007. Epub 2011 Mar 22.
Cancer and venous thromboembolism are frequently associated.
Venous thromboembolism is associated with a worse prognosis in patients with cancer. Thrombosis in cancer patients is related to the expression of tissue factor and other procoagulants by tumour cells. Surgery, chemotherapy and antiangiogenic agents are also associated with an increased risk of thrombosis. Venous thromboembolism may be the first manifestation of cancer, the risk being especially increased during the first six months following an unexplained episode of idiopathic thrombosis. Current evidence does not suggest that a systematic screening for cancer after an unexplained thrombosis is associated with a clinical benefit. Risk factors for thrombosis specific to the cancer population have been identified. A recent controlled trial suggests that low-molecular weight heparin may reduce the incidence of venous thromboembolism in patients with cancer. These results need to be confirmed. Treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin administered for three or six months.
Low-molecular weight heparin may increase the survival of patients with cancer through a direct effect on tumour biology. Several clinical trials are underway to confirm this hypothesis.
Thrombosis in cancer patients is a frequent and difficult to treat condition. The role of long-term prophylaxis remains to be defined. The treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin. Large clinical trials are currently assessing the effect of low-molecular weight heparin on the long-term survival of patients with cancer.
癌症与静脉血栓栓塞常常相关。
静脉血栓栓塞与癌症患者预后较差相关。癌症患者的血栓形成与肿瘤细胞组织因子及其他促凝剂的表达有关。手术、化疗及抗血管生成药物也与血栓形成风险增加相关。静脉血栓栓塞可能是癌症的首发表现，在不明原因的特发性血栓形成发作后的头六个月内风险尤其增加。目前的证据并不表明在不明原因的血栓形成后进行系统性癌症筛查会带来临床益处。已确定了癌症人群特有的血栓形成危险因素。最近一项对照试验表明，低分子量肝素可能降低癌症患者静脉血栓栓塞的发生率。这些结果有待证实。癌症患者静脉血栓栓塞的治疗主要基于使用低分子量肝素三至六个月。
低分子量肝素可能通过对肿瘤生物学的直接作用提高癌症患者的生存率。正在进行多项临床试验以证实这一假设。
癌症患者的血栓形成是一种常见且难以治疗的病症。长期预防的作用仍有待确定。癌症患者静脉血栓栓塞的治疗主要基于低分子量肝素。大型临床试验目前正在评估低分子量肝素对癌症患者长期生存的影响。
