Cattedra ed UO di Ematologia con trapianto, Dipartimento di Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico di Palermo, Via del Vespro 127, 90127 Palermo, Italy.
Thromb Res. 2012 May;129(5):e171-6. doi: 10.1016/j.thromres.2011.09.002. Epub 2011 Oct 2.
Prevention of venous thromboembolism (VTE) in cancer patients remains controversial in most clinical settings.
The Italian Society for Haemostasis and Thrombosis (SISET) commissioned a project to develop clinical practice guidelines for the prevention of VTE in patients with malignancy.
Key questions concerning the prevention of VTE in patients with malignancy were formulated by a multidisciplinary working group consisting of experts in clinical medicine and research. After a systematic review and discussion of the literature, recommendations were formulated and graded according to the supporting evidence. For those questions for which the literature search did not find any definitive answers (due to absence of evidence, low quality evidence and/or contradictory evidence), a formal consensus method was used instead to issue clinical recommendations.
The search for "VTE prevention" resulted in 1021 citations; 69 articles were selected and 24 were used for drafting clinical recommendations. Four areas were graded A to C: 1) Need of prevention (pharmacological and/or mechanical) in cancer patients undergoing major abdominal or pelvic surgery and in 2) those with an acute medical disease requiring hospitalization and who are bedridden. Avoid prevention in 3) cancer patients with a central venous catheter and 4) those on chemotherapy, radiotherapy or hormonal therapy, except patients with multiple myeloma treated with thalidomide/lenalidomide plus high-dose dexamethasone, and those with gastrointestinal or lung cancer. Six areas were considered to be clinically important, but lacked evidence from the literature and thus required a formal consensus (grade D): 1) need of prevention during chemo- radiotherapy or hormonal therapy in patients with previous VTE; 2) optimal duration of pharmacological prevention in patients who are hospitalized/bedridden for acute medical illness; 3) optimal duration of pharmacological prevention in patients undergoing major surgery other than abdominal and pelvic; 4) optimal duration of pharmacological prevention in myeloma patients receiving thalidomide plus dexamethasone; 5) presence of cerebral metastasis as a contraindication to pharmacological prevention; 6) prevention in cancer patients undergoing surgery by laparoscopic procedures lasting>30min.
Results of the systematic literature review and an explicit approach to consensus techniques have led to recommendations for the most clinically important issues in the prevention of VTE in cancer patients.
在大多数临床情况下，癌症患者静脉血栓栓塞症（VTE）的预防仍然存在争议。
意大利血栓与止血学会（SISET）委托开展了一个项目，制定恶性肿瘤患者 VTE 预防的临床实践指南。
由临床和研究方面的多学科专家组成的工作组提出了关于恶性肿瘤患者 VTE 预防的关键问题。在对文献进行系统回顾和讨论后，根据证据支持情况制定并分级了建议。对于文献检索未发现明确答案的问题（由于缺乏证据、证据质量低和/或证据相互矛盾），则采用正式共识方法来发布临床建议。
搜索“VTE 预防”产生了 1021 条引文；选择了 69 篇文章，并使用其中 24 篇来起草临床建议。四个领域被评为 A 至 C 级：1）需要预防（药物和/或机械）的癌症患者包括接受大腹部或骨盆手术的患者和 2）因急性内科疾病需要住院且卧床的患者。避免预防 3）患有中央静脉导管的癌症患者和 4）正在接受化疗、放疗或激素治疗的癌症患者，但多发性骨髓瘤患者接受沙利度胺/来那度胺联合高剂量地塞米松治疗和胃肠道或肺癌患者除外。六个领域被认为具有临床重要性，但缺乏文献证据，因此需要正式共识（D 级）：1）有 VTE 既往史的患者在接受化疗-放疗或激素治疗期间需要预防；2）因急性内科疾病住院/卧床的患者进行药物预防的最佳持续时间；3）接受非腹部和骨盆大手术的患者进行药物预防的最佳持续时间；4）接受沙利度胺联合地塞米松治疗的多发性骨髓瘤患者进行药物预防的最佳持续时间；5）脑转移作为药物预防的禁忌症；6）手术时间超过 30 分钟的腹腔镜手术的癌症患者的预防。
系统文献回顾的结果和明确的共识技术方法导致了针对癌症患者 VTE 预防中最具临床意义的问题的建议。
