Ihaddadene Ryma, Le Gal Grégoire, Delluc Aurélien, Carrier Marc
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario Canada.
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario Canada; Département de Médecine Interne, EA3878, University of Brest, Brest, France.
Thromb Res. 2014 Jul;134(1):93-5. doi: 10.1016/j.thromres.2014.04.028. Epub 2014 May 2.
Patients with cancer-associated thrombosis are at a high risk of developing recurrent events despite anticoagulant therapy. Escalation of the dose of low molecular weight heparin (LMWH) has been suggested as a potential treatment option to manage these patients. We sought to confirm the benefit and risk of this management strategy in patients with recurrent cancer-associated thrombosis.
A retrospective cohort study of consecutive cancer outpatients seen for management of a symptomatic recurrent cancer-associated thrombosis while on anticoagulation was undertaken. Objectively confirmed episodes of recurrent thrombosis were treated with either dose escalation of LMWH or initiation of therapeutic dose of LMWH in patients already anticoagulated with LMWH or vitamin K antagonist (VKA) respectively. Included patients were followed for a minimum of 3 months after the index recurrent event.
Fifty-five cancer patients with a recurrent venous thromboembolism (VTE) despite anticoagulation were included. At the time of the recurrence, 89% of patients were on LMWH. The median time between the initial cancer-associated thrombosis to the index recurrent event was 2.3 months (range 0.1 to 30.4 months). Four patients (7.3%; 95% CI: 2.0 to 17.6%) had a second recurrent VTE during the 3-month follow-up period. Three patients (5.5%; 95% CI 1.1 to 15.1%) had major bleeding complications after dose escalation of LMWH. There were no recurrent fatal VTE or major bleeding episodes.
Escalating the dose of LMWH seems effective and safe for managing patients with recurrent cancer-associated thrombosis despite anticoagulant therapy.
尽管接受了抗凝治疗，但癌症相关血栓形成的患者仍有很高的复发风险。有人建议增加低分子量肝素（LMWH）的剂量作为治疗这些患者的一种潜在选择。我们试图证实这种管理策略对复发性癌症相关血栓形成患者的益处和风险。
对连续的癌症门诊患者进行回顾性队列研究，这些患者在接受抗凝治疗时因有症状的复发性癌症相关血栓形成而前来就诊。对于客观证实的复发性血栓形成事件，分别对已接受LMWH或维生素K拮抗剂（VKA）抗凝治疗的患者，采用增加LMWH剂量或开始使用治疗剂量的LMWH进行治疗。纳入的患者在首次复发性事件后至少随访3个月。
纳入了55例尽管接受了抗凝治疗仍发生复发性静脉血栓栓塞（VTE）的癌症患者。复发时，89%的患者正在使用LMWH。从最初的癌症相关血栓形成到首次复发性事件的中位时间为2.3个月（范围0.1至30.4个月）。在3个月的随访期内，4例患者（7.3%；95%CI：2.0至17.6%）发生了第二次复发性VTE。3例患者（5.5%；95%CI 1.1至15.1%）在LMWH剂量增加后出现了严重出血并发症。没有复发性致命VTE或严重出血事件。
对于尽管接受了抗凝治疗但仍患有复发性癌症相关血栓形成的患者，增加LMWH的剂量似乎有效且安全。
