Vascular Medicine, Department of Vascular Surgery, King's College Hospital, London, UK.
Thromb Res. 2012 Apr;129 Suppl 1:S137-45. doi: 10.1016/S0049-3848(12)70034-8.
Acutely ill medical patients with cancer and cancer patients requiring non-surgical therapy are considered as non-surgical cancer patients and are at moderate to high risk of venous thromboembolism (VTE): approximately 10-30% of these patients may develop asymptomatic or symptomatic deep-vein thrombosis (DVT) or pulmonary embolism (PE), and the latter is a leading contributor to deaths in hospital. Other medical conditions associated with a high risk of VTE include cardiac disease, respiratory disease, inflammatory bowel disease, rheumatological and infectious diseases. Pre-disposing risk factors in non-surgical cancer patients include a history of VTE, immobilisation, history of metastatic malignancy, complicating infections, increasing age, obesity hormonal or antiangiogenic therapies, thalidomide and lenalidomide therapy. Heparins, both unfractionated (UFH) and low molecular weight heparin (LMWH) and fondaparinux have been shown to be effective agents in prevention of VTE in the medical setting with patients having a history of cancer. UFH and LMWH along with semuloparin also have a role in outpatients with cancer receiving chemotherapy. However, it has not yet been possible to demonstrate a significant effect on mortality rates in this population. UFH has a higher rate of bleeding complications than LMWH. Thromboprophylaxis has been shown to be effective in medical patients with cancer and may have an effect on cancer outcomes. Thromboprophylaxis in patients receiving chemotherapy remains controversial and requires further investigation. There is no evidence for the use of aspirin, warfarin or mechanical methods. We recommend either LMWH, or fondaparinux for the prevention of VTE in cancer patients with acute medical illnesses and UFH for those with significant severe renal impairment. For ambulatory cancer patients undergoing chemotherapy we recommend LMWH or semuloparin. These are safe and effective agents in the thromboprophylaxis of non-surgical cancer patients.
患有癌症的重病医学患者和需要非手术治疗的癌症患者被视为非手术癌症患者，他们有中度至高度的静脉血栓栓塞（VTE）风险：这些患者中约有 10-30%可能会出现无症状或有症状的深静脉血栓形成（DVT）或肺栓塞（PE），后者是导致医院死亡的主要原因。其他与高 VTE 风险相关的医疗状况包括心脏病、呼吸疾病、炎症性肠病、风湿性和传染性疾病。非手术癌症患者的易患风险因素包括 VTE 病史、固定不动、转移性恶性肿瘤病史、并发感染、年龄增长、肥胖、激素或抗血管生成治疗、沙利度胺和来那度胺治疗。肝素，包括未分馏肝素（UFH）和低分子肝素（LMWH）和磺达肝素已被证明在有癌症病史的患者中对预防 VTE 有效。UFH 和 LMWH 以及磺达肝素在接受化疗的癌症门诊患者中也有作用。然而，在这一人群中，尚未能证明对死亡率有显著影响。UFH 的出血并发症发生率高于 LMWH。血栓预防已被证明对患有癌症的医学患者有效，并且可能对癌症结果有影响。接受化疗的患者的血栓预防仍存在争议，需要进一步研究。没有证据表明阿司匹林、华法林或机械方法有用。我们建议在患有急性内科疾病的癌症患者中使用 LMWH 或磺达肝素预防 VTE，并在有严重肾功能损害的患者中使用 UFH。对于接受化疗的活动性癌症患者，我们建议使用 LMWH 或磺达肝素。这些是在非手术癌症患者的血栓预防中安全有效的药物。
