Streiff Michael B
Johns Hopkins Medical Institutions, Baltimore, Maryland.
Clin Adv Hematol Oncol. 2013 Jun;11(6):349-57.
Nearly 20% of all venous thromboembolism (VTE) occurs in cancer patients, and as many as 78% of cancer patients who develop a thrombotic event do so as outpatients. The risk of VTE in cancer patients is influenced by the type of cancer, its stage and histology, the presence of thrombophilia, and the many therapeutic interventions they receive (eg, surgery, chemotherapy, radiotherapy, supportive care). The greatest VTE risk appears to occur early after cancer diagnosis and in patients with late- or metastatic-stage malignancy. VTE most often occurs in cancers of the pancreas, ovary, kidney, lung, stomach, and brain, as well as in hematologic malignancies such as lymphoma and myeloma. The clinical consequences of thrombosis in cancer patients are typically more severe and more costly than events in patients without cancer. Patient-, cancer-, and treatment-related factors should be considered when assessing individual patients for their risk of VTE. Primary pharmacologic VTE prophylaxis should be given to all hospitalized medical and surgical oncology patients at risk, and this therapy should be considered for high-risk ambulatory outpatients (eg, myeloma patients receiving highly thrombogenic chemotherapeutic regimens, very-high-risk solid tumor patients with Khorana scores ≥3) who have no contraindications to anticoagulants.
所有静脉血栓栓塞症（VTE）中近20%发生于癌症患者，且发生血栓事件的癌症患者中多达78%是在门诊时发病。癌症患者发生VTE的风险受癌症类型、分期和组织学、血栓形成倾向的存在以及他们接受的多种治疗干预（如手术、化疗、放疗、支持治疗）影响。VTE风险似乎在癌症诊断后早期以及晚期或转移性恶性肿瘤患者中最高。VTE最常发生于胰腺癌、卵巢癌、肾癌、肺癌、胃癌和脑癌，以及淋巴瘤和骨髓瘤等血液系统恶性肿瘤。癌症患者血栓形成的临床后果通常比非癌症患者的事件更严重且成本更高。在评估个体患者的VTE风险时，应考虑患者、癌症和治疗相关因素。所有有风险的住院内科和外科肿瘤患者均应给予主要的药物性VTE预防，对于无抗凝剂禁忌证的高危门诊患者（如接受高血栓形成风险化疗方案的骨髓瘤患者、Khorana评分≥3的极高风险实体瘤患者）也应考虑这种治疗。
