Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France.
Support Care Cancer. 2012 Dec;20(12):3033-42. doi: 10.1007/s00520-012-1590-9. Epub 2012 Sep 9.
Venous thromboembolism (VTE) and renal insufficiency are common in cancer patients. Prompt treatment is necessary to reduce the high rates of VTE-related mortality and morbidity. VTE prophylaxis is underused in cancer patients. We review current recommendations for the treatment and prevention of VTE in cancer patients and discuss low molecular weight heparin (LMWH) use in cases of renal failure.
This study is a retrospective literature review.
There are few published recommendations for LMWH use in cancer patients with renal insufficiency. Treatment guidelines largely follow recommendations for other patients with renal failure. Enoxaparin therapy is complicated by the need for regular monitoring of renal function and anti-Xa levels and for dosage adjustment to prevent bleeding. Few data are available to support the systematic use of dalteparin. Tinzaparin is least likely to bioaccumulate in patients with renal failure.
VTE is the second most common cause of death in cancer patients. Renal insufficiency is present in 50-60 % of cancer patients. Data from renal patients suggest that tinzaparin may be safe and effective for VTE treatment and prevention in cancer patients with renal failure.
静脉血栓栓塞症（VTE）和肾功能不全在癌症患者中很常见。为了降低与 VTE 相关的高死亡率和发病率，必须及时进行治疗。癌症患者中 VTE 的预防措施未得到充分应用。我们回顾了癌症患者 VTE 的治疗和预防的现行建议，并讨论了在肾功能衰竭情况下低分子肝素（LMWH）的使用。
这是一项回顾性文献研究。
关于肾功能不全的癌症患者使用 LMWH 的建议很少有文献报道。治疗指南主要遵循其他肾功能衰竭患者的建议。依诺肝素治疗因需要定期监测肾功能和抗 Xa 水平以及调整剂量以防止出血而变得复杂。支持系统使用达肝素的数据很少。在肾功能衰竭患者中，替扎肝素的生物蓄积性最小。
VTE 是癌症患者的第二大常见死亡原因。肾功能不全在 50-60%的癌症患者中存在。来自肾功能衰竭患者的数据表明，替扎肝素可能对癌症合并肾功能衰竭患者的 VTE 治疗和预防是安全有效的。
