Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Thromb Res. 2012 Apr;129 Suppl 1:S146-53. doi: 10.1016/S0049-3848(12)70035-X.
Acutely ill medical patients with cancer and cancer patients requiring Anticoagulants remain the cornerstone of therapy for venous thromboembolism. In patients with cancer, monotherapy with low molecular weight heparin (LMWH) is preferred over initial therapy with heparin followed by long-term treatment with vitamin K antagonists (VKA) because it is more efficacious and does not interfere with chemotherapy. The shorter duration of action of LMWHs compared with VKAs also offers greater flexibility to accommodate invasive procedures and thrombocytopenia. Newer oral antithrombotic agents may further simplify treatment of cancer-associated thrombosis because they are given at fixed doses and do not require laboratory monitoring of their anticoagulant effect. However, there are very limited data and experience with these agents in patients with cancer and some of these drugs do interact with a number of chemotherapeutic agents. Other unanswered clinical questions include the optimal duration of anticoagulant therapy, which anticoagulant to use after 6 months of treatment, how to treat patients with recurrent thrombosis or patients with a high risk for bleeding. Formal studies are needed to address these unmet clinical needs.
患有癌症的重病医学患者和需要抗凝剂的癌症患者仍然是静脉血栓栓塞症治疗的基石。对于癌症患者，与最初使用肝素然后长期使用维生素 K 拮抗剂 (VKA) 相比，低分子量肝素 (LMWH) 的单一疗法更有效，并且不会干扰化疗。与 VKA 相比，LMWH 的作用持续时间更短，这也为适应侵入性手术和血小板减少症提供了更大的灵活性。新型口服抗血栓药物可能会进一步简化癌症相关血栓形成的治疗，因为它们以固定剂量给药，并且不需要实验室监测其抗凝效果。然而，这些药物在癌症患者中的数据和经验非常有限，并且有些药物会与许多化疗药物相互作用。其他未解决的临床问题包括抗凝治疗的最佳持续时间、治疗 6 个月后使用哪种抗凝剂、如何治疗复发性血栓形成或有高出血风险的患者。需要进行正式研究来解决这些未满足的临床需求。
