Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Thromb Haemost. 2012 Dec;108(6):1042-8. doi: 10.1160/TH12-04-0241. Epub 2012 Jul 26.
Cancer patients are at increased risk of developing venous thromboembolism (VTE). Guidelines recommend routine thromboprophylaxis in hospitalised acutely ill cancer patients and in myeloma patients receiving combination treatments including thalidomide or lenalidomide. Currently, thromboprophylaxis is not recommended in cancer outpatients. It is the aim of this review to give an overview of studies that applied scores for the risk assessment of cancer-related VTE. We will also discuss randomised controlled trials (RCTs) that investigated primary thromboprophylaxis in cancer patients. Recently, Khorana et al. published a practical and reproducible risk assessment score that includes clinical and laboratory parameters for the stratification of cancer patients according to their propensity to develop VTE. Patients assigned to the high-risk group are likely to benefit most from primary thromboprophylaxis. This score was validated in prospective and retrospective observational studies. In the Vienna Cancer and Thrombosis Study (CATS) the score was expanded by adding two biomarkers, and the prediction of VTE was considerably improved. In recent RCTs including cancer patients with different malignancies it was shown that thromboprophylaxis is safe and effective. However, VTE incidence rates were low. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorised into high-risk groups on the basis of risk assessment with scores. From the available literature we conclude that risk assessment for VTE is feasible in cancer patients; however, interventional studies to investigate the safety and efficacy of thromboprophylaxis in a high risk cancer population have yet to be performed.
癌症患者发生静脉血栓栓塞症（VTE）的风险增加。指南建议对住院急性重症癌症患者和接受包括沙利度胺或来那度胺的联合治疗的骨髓瘤患者进行常规血栓预防。目前，不建议对癌症门诊患者进行血栓预防。本综述的目的是概述应用癌症相关 VTE 风险评估评分的研究。我们还将讨论调查癌症患者一级预防血栓的随机对照试验（RCT）。最近，Khorana 等人发表了一种实用且可重复的风险评估评分，该评分包括临床和实验室参数，用于根据癌症患者发生 VTE 的倾向对其进行分层。被分配到高风险组的患者很可能从一级预防血栓中获益最大。该评分在前瞻性和回顾性观察性研究中得到了验证。在维也纳癌症和血栓形成研究（CATS）中，该评分通过添加两个生物标志物进行了扩展，并且 VTE 的预测得到了显著改善。在最近包括不同恶性肿瘤的癌症患者的 RCT 中，证明了血栓预防是安全有效的。然而，VTE 的发生率很低。迄今为止，没有基于评分进行风险评估并将癌症患者分为高危组进行血栓预防的干预性研究的数据。根据现有文献，我们得出结论，VTE 的风险评估在癌症患者中是可行的；然而，仍需要开展研究以调查高危癌症人群中预防血栓的安全性和有效性。
