James P. Wilmot Cancer Center, and Department of Medicine, University of Rochester, Rochester, NY, USA.
Thromb Res. 2012 Apr;129 Suppl 1:S10-5. doi: 10.1016/S0049-3848(12)70009-9.
Venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments. One in five cancer patients are estimated to develop venous and arterial events during the natural history of their illness. However, the risk for VTE varies widely between various subgroups of cancer patients and even in the same cancer patient over time. This narrative review focuses on risk factors, biomarkers and risk assessment tools and attempts to clarify approaches to risk stratification. Clinical risk factors include primary site of cancer, chemotherapy, anti-angiogenic therapy, surgery and hospitalization. Predictive and candidate biomarkers include platelet and leukocyte counts, hemoglobin, D-dimer and tissue factor. However, single risk factors or biomarkers have not, in general, been able to identify sufficiently high-risk populations. A clinical risk score, incorporating 5 simple clinical and laboratory variables, has now been studied in over 10,000 patients and can successfully categorize patients at low- and high-risk for VTE. Recent trials have shown that outpatient prophylactic anticoagulation is both safe and effective, but event rates have been highly variable. Targeted thromboprophylaxis provides an optimal risk-benefit ratio and the best opportunity to reduce the burden of VTE and its consequences for patients with cancer.
静脉血栓栓塞症（VTE）是癌症及其治疗中越来越常见的并发症。据估计，五分之一的癌症患者在疾病自然史中会发生静脉和动脉事件。然而，VTE 的风险在不同癌症患者亚组之间差异很大，甚至在同一癌症患者中随时间变化。本叙述性综述重点介绍了风险因素、生物标志物和风险评估工具，并尝试阐明风险分层的方法。临床风险因素包括癌症的原发部位、化疗、抗血管生成治疗、手术和住院治疗。预测性和候选生物标志物包括血小板和白细胞计数、血红蛋白、D-二聚体和组织因子。然而，一般来说，单一的风险因素或生物标志物还无法确定足够高风险的人群。目前已经在超过 10000 名患者中研究了一种包含 5 个简单临床和实验室变量的临床风险评分，可以成功地将患者分为低风险和高风险的 VTE。最近的试验表明，门诊预防性抗凝治疗既安全又有效，但事件发生率差异很大。靶向性血栓预防提供了最佳的风险效益比，为减少癌症患者 VTE 负担及其后果提供了最佳机会。
