Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, UK.
Eur J Cancer. 2012 Jun;48(9):1283-92. doi: 10.1016/j.ejca.2011.10.017. Epub 2011 Nov 17.
Annualised figures show an up to 7-fold higher incidence of vascular thromboembolism (VTE) in patients with advanced pancreatic cancer (APC) compared to other common malignancies. Concurrent VTE has been shown to confer a worse overall prognosis in APC.
One hundred and twenty three APC patients were randomised to receive either gemcitabine 1000 mg/m(2) or the same with weight-adjusted dalteparin (WAD) for 12 weeks. Primary end-point was the reduction of all-type VTE during the study period. NCT00462852, ISRCTN: 76464767.
The incidence of all-type VTE during the WAD treatment period (<100 days from randomisation) was reduced from 23% to 3.4% (p = 0.002), with a risk ratio (RR)of 0.145, 95% confidence interval (CI) (0.035-0.612) and an 85% risk reduction. All-type VTE throughout the whole follow-up period was reduced from 28% to 12% (p = 0.039), RR = 0.419, 95% CI (0.187-0.935) and a 58% risk reduction. Lethal VTE <100 days was seen only in the control arm, 8.3% compared to 0% (p = 0.057), RR = 0.092, 95% CI (0.005-1.635).
Weight adjusted dalteparin used as primary prophylaxis for 12 weeks is safe and produces a highly significant reduction of all-type VTE during the prophylaxis period. The benefit is maintained after dalteparin withdrawal although decreases with time.
与其他常见恶性肿瘤相比，晚期胰腺癌（APC）患者的血管血栓栓塞（VTE）发病率高达 7 倍。已证实 APC 中并发的 VTE 会导致整体预后更差。
123 例 APC 患者被随机分为接受吉西他滨 1000mg/m2 或相同剂量联合体重调整达肝素（WAD）治疗 12 周。主要终点是研究期间所有类型 VTE 的减少。NCT00462852，ISRCTN: 76464767。
WAD 治疗期间（随机分组后<100 天）所有类型 VTE 的发生率从 23%降至 3.4%（p=0.002），风险比（RR）为 0.145，95%置信区间（CI）（0.035-0.612），风险降低 85%。整个随访期间所有类型 VTE 从 28%降至 12%（p=0.039），RR=0.419，95%CI（0.187-0.935），风险降低 58%。<100 天的致死性 VTE 仅见于对照组，8.3%比 0%（p=0.057），RR=0.092，95%CI（0.005-1.635）。
体重调整达肝素作为一线预防措施，使用 12 周是安全的，可显著降低预防期间的所有类型 VTE。在停止达肝素后仍能保持获益，尽管随时间而减少。
