Mahé Isabelle, Chidiac Jean
Médecine interne, Hôpital Louis-Mourier, université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, APHP, 178, rue des Renouillers, 92700 Colombes, France.
Bull Cancer. 2014 Mar;101(3):295-301. doi: 10.1684/bdc.2014.1907.
Low-molecular-weight heparins (LMWH) are the reference curative treatment of venous thromboembolism (VTE) in patients with cancer. All international guidelines recommend the long-term use of LMWH given their demonstrated superiority compared to vitamin-K antagonists (VKA) in reducing VTE recurrence in this patient population without increased risk of bleeding. However, several studies consistently show a lack of adherence to treatment recommendations, which are applied at the very best in 50% of cases. This results in a loss of chance for patients with fragile prognosis and in whom VTE represents the second cause of death. Given the expected benefit and the increased VTE prevalence in patients with cancer, full awareness is necessary to implement programs aiming at improving the therapeutic management of cancer-associated VTE. This requires multidisciplinary consideration by qualified physicians involved in the management of patients with cancer-associated VTE such as oncologists, internists and those specialized in vascular disease and hemostasis.
低分子量肝素(LMWH)是癌症患者静脉血栓栓塞症(VTE)的标准治疗方法。所有国际指南均推荐长期使用LMWH,因为与维生素K拮抗剂(VKA)相比,LMWH在降低该患者群体VTE复发风险方面具有显著优势,且不会增加出血风险。然而,多项研究一致表明,治疗建议的依从性不足,在最多50%的病例中得到了应用。这导致预后不佳且VTE是第二大死因的患者失去了治疗机会。鉴于癌症患者VTE患病率上升以及预期的获益,充分认识到实施旨在改善癌症相关VTE治疗管理的项目的必要性。这需要参与癌症相关VTE患者管理的合格医生进行多学科考量,如肿瘤学家、内科医生以及血管疾病和止血方面的专家。