Kreher S, Riess H
Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland,
Internist (Berl). 2014 Apr;55(4):448-54. doi: 10.1007/s00108-014-3476-z.
Venous thromboembolism (VTE) is a common complication in patients with cancer. Because of their improved subcutaneous bioavailability and reliable antithrombotic efficiency low-molecular-weight heparins (LMWH) are preferably used for prevention and treatment of cancer-related VTE. Thromboprophylaxis with LMWH is well established in patients undergoing cancer surgery and hospitalized cancer patients, while outpatient prophylaxis remains contentious. LMWH are recommended over unfractionated heparins and vitamin K antagonists for initial treatment and secondary prophylaxis (3-6 months) after cancer-related VTE. Long-term secondary prophylaxis should be considered for patients with ongoing active malignancy and low bleeding risk. Due to absence of clinical studies in cancer patients, the use of novel oral anticoagulants is currently not recommended.
静脉血栓栓塞症（VTE）是癌症患者常见的并发症。低分子量肝素（LMWH）因其皮下生物利用度提高且抗血栓效率可靠，故而更常用于预防和治疗癌症相关的VTE。在接受癌症手术的患者和住院癌症患者中，使用LMWH进行血栓预防已得到充分确立，而门诊预防仍存在争议。对于癌症相关VTE后的初始治疗和二级预防（3 - 6个月），推荐使用LMWH而非普通肝素和维生素K拮抗剂。对于持续存在活动性恶性肿瘤且出血风险低的患者，应考虑长期二级预防。由于缺乏针对癌症患者的临床研究，目前不推荐使用新型口服抗凝药。
