Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Onco Targets Ther. 2015 Jan 27;8:243-9. doi: 10.2147/OTT.S75722. eCollection 2015.
Doppler ultrasound imaging is useful for management of venous thromboembolism associated with a subclavicular implantable central venous access system in patients receiving bevacizumab (Bev). We investigated the efficacy and safety of our anticoagulant regimen based on Doppler findings.
Patients aged ≤75 years with metastatic colorectal cancer, no history of thromboembolism, and no prior use of Bev received chemotherapy plus Bev. Doppler ultrasound imaging of the deep venous system to detect thrombosis was performed after the first course of Bev and repeated after the third course in patients with asymptomatic thrombosis. Indications for anticoagulant therapy in patients with asymptomatic thrombosis were as follows: enlarging thrombus (E), thrombus >40 mm in diameter (S), thrombus involving the superior vena cava (C), and decreased blood flow (V).
Among 79 patients enrolled in this study, asymptomatic thrombosis was detected in 56 patients (70.9%) by Doppler ultrasound imaging after the first course of Bev and there was no thrombus in 23 patients (29.1%). Of these 56 patients, 11 (19.6%) received anticoagulant therapy with warfarin, including eight after the first course and three after follow-up imaging. S + V was observed in four of 11 patients (36.4%), as well as V in two (18.2%), S + V + C in one (9.1%), E + S + V in one (9.1%), E + C in one (9.1%), E in one (9.1%), and C in one (9.1%). All patients resumed chemotherapy, including seven who resumed Bev. Improvement or stabilization of thrombi was achieved in ten patients (90.9%). Only one patient had symptomatic thromboembolism. Mild bleeding due to anticoagulant therapy occurred in six patients (54.5%), but there were no treatment-related severe adverse events or deaths. Severe thromboembolism was not observed in the other 68 patients.
Our anticoagulant protocol for asymptomatic thrombosis detected by Doppler ultrasound imaging was effective at preventing severe thromboembolism during continued treatment with Bev.
在接受贝伐珠单抗（Bev）治疗的患者中，锁骨下植入式中心静脉通路系统相关的静脉血栓栓塞症，多普勒超声成像有助于管理。我们根据多普勒检查结果，研究了我们抗凝方案的疗效和安全性。
年龄≤75 岁、转移性结直肠癌、无血栓栓塞史且无 Bev 既往使用史的患者接受化疗联合 Bev。在 Bev 首疗程后，对深静脉系统进行多普勒超声成像以检测血栓形成，在无症状性血栓形成患者中，在第三个疗程后重复进行检查。在无症状性血栓形成患者中，抗凝治疗的指征如下：血栓增大（E）、血栓直径＞40mm（S）、血栓累及上腔静脉（C）和血流减少（V）。
在这项研究中，79 例患者中有 56 例（70.9%）在 Bev 首疗程后通过多普勒超声成像检测到无症状性血栓形成，23 例（29.1%）无血栓形成。在这 56 例患者中，11 例（19.6%）接受了华法林抗凝治疗，其中 8 例在首疗程后，3 例在随访影像学检查后。11 例患者中，有 4 例（36.4%）出现 S+V，2 例（18.2%）出现 V，1 例（9.1%）出现 S+V+C，1 例（9.1%）出现 E+S+V，1 例（9.1%）出现 E+C，1 例（9.1%）出现 E，1 例（9.1%）出现 C。所有患者均恢复化疗，其中 7 例恢复 Bev 治疗。10 例（90.9%）患者的血栓得到改善或稳定。仅有 1 例患者出现症状性血栓栓塞症。6 例（54.5%）患者出现抗凝治疗相关轻度出血，但无治疗相关严重不良事件或死亡。在其他 68 例患者中未观察到严重血栓栓塞症。
我们通过多普勒超声成像检测无症状性血栓形成的抗凝方案，在继续接受 Bev 治疗期间，有效预防了严重血栓栓塞症的发生。
