癌症患者的静脉血栓栓塞预防与治疗：美国临床肿瘤学会2014年临床实践指南更新
Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014.
作者信息
Lyman Gary H, Bohlke Kari, Khorana Alok A, Kuderer Nicole M, Lee Agnes Y, Arcelus Juan Ignacio, Balaban Edward P, Clarke Jeffrey M, Flowers Christopher R, Francis Charles W, Gates Leigh E, Kakkar Ajay K, Key Nigel S, Levine Mark N, Liebman Howard A, Tempero Margaret A, Wong Sandra L, Somerfield Mark R, Falanga Anna
机构信息
Gary H. Lyman, Fred Hutchinson Cancer Research Center; Gary H. Lyman and Nicole M. Kuderer, University of Washington, Seattle, WA; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Alok A. Khorana, Cleveland Clinic, Cleveland, OH; Agnes Y. Lee, University of British Columbia, Vancouver, British Columbia; Mark N. Levine, McMaster University, Hamilton, Ontario, Canada; Juan Ignacio Arcelus, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain; Edward P. Balaban, Cancer Care Partnership, Mount Nittany Health and Penn State Hershey Cancer Institute, State College, PA; Jeffrey M. Clarke, Duke University Medical Center, Durham; Nigel S. Key, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Charles W. Francis, James P. Wilmot Cancer Center and University of Rochester, Rochester, NY; Leigh E. Gates, Patient Representative, Denver, CO; Ajay K. Kakkar, Thrombosis Research Institute, London, United Kingdom; Howard A. Liebman, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles; Margaret A. Tempero, University of California San Francisco Pancreas Center, San Francisco, CA; Sandra L. Wong, University of Michigan, Ann Arbor, MI; and Anna Falanga, Hospital Papa Giovanni XXIII, Bergamo, Italy.
出版信息
J Clin Oncol. 2015 Feb 20;33(6):654-6. doi: 10.1200/JCO.2014.59.7351. Epub 2015 Jan 20.
PURPOSE
To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.
METHODS
PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts.
RESULTS
Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations.
RECOMMENDATIONS
Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.
目的
提供关于癌症患者静脉血栓栓塞（VTE）预防和治疗的当前建议。
方法
检索2012年11月至2014年7月期间的PubMed和Cochrane图书馆，查找随机对照试验、系统评价、荟萃分析和临床实践指南。一个更新委员会对筛选出的摘要进行了审查。
结果
在筛选并审查的53篇出版物中，没有一篇促使对2013年的建议进行更改。
建议
大多数住院的活动性癌症患者在整个住院期间都需要进行血栓预防。不建议对门诊癌症患者进行常规血栓预防。对于选定的高危患者可考虑进行预防。接受抗血管生成药物联合化疗和/或地塞米松治疗的多发性骨髓瘤患者应接受低分子量肝素（LMWH）或小剂量阿司匹林预防。接受大手术的患者应在手术前开始预防，并持续至少7至10天。对于具有高危特征的接受大型腹部或盆腔手术的患者，应考虑将预防延长至4周。对于深静脉血栓形成和肺栓塞的初始治疗以及长期二级预防（至少6个月），建议使用LMWH 5至10天。由于癌症患者的数据有限，目前不建议对患有恶性肿瘤和VTE的患者使用新型口服抗凝剂。在没有其他指征的情况下，不应使用抗凝剂来延长癌症患者的生存期。应定期评估癌症患者的VTE风险。肿瘤学专业人员应向患者宣传VTE的体征和症状。
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