Verso Melina, Agnelli Giancarlo, Prandoni Paolo
Medicina Interna e Cardiovascolare-Stroke Unit, Dipartimento di Medicina Interna, Università di Perugia, Via Gerardo Dottori, 06100, Perugia, Italy,
Intern Emerg Med. 2015 Sep;10(6):651-6. doi: 10.1007/s11739-015-1233-5. Epub 2015 Apr 4.
Patients with cancer account for 20 % of cases of venous thromboembolism (VTE). Cancer patients are at increased risk for VTE during the entire course of their disease, also in absence of traditional VTE risk factors. Furthermore, patients with VTE and cancer have an estimated risk of bleeding of 15-20 % per year while on anticoagulant treatment. For these reasons, treatment of acute VTE in patients with cancer remains a clinical challenge. In clinical studies, which included about 27,000 patients, new oral anticoagulants (NOACs) have been shown to be as effective and safe as conventional anticoagulation (heparin given with and followed by vitamin K antagonists) for the treatment of VTE. In these studies, 1227 patients with active cancer were enrolled. Preliminary results of subgroup analyses and meta-analyses of randomized clinical trials suggest that NOACs could represent an alternative to conventional anticoagulation in patients with active cancer. Further "ad hoc" studies evaluating the clinical benefit of treatment with NOACs in patients with VTE and cancer are needed.
癌症患者占静脉血栓栓塞症（VTE）病例的20%。癌症患者在其疾病的整个过程中发生VTE的风险都会增加，即便不存在传统的VTE风险因素。此外，VTE合并癌症的患者在接受抗凝治疗时，每年发生出血的风险估计为15% - 20%。鉴于这些原因，癌症患者急性VTE的治疗仍然是一项临床挑战。在纳入了约27000名患者的临床研究中，新型口服抗凝剂（NOACs）已被证明在治疗VTE方面与传统抗凝治疗（肝素联合维生素K拮抗剂并序贯使用）一样有效且安全。在这些研究中，纳入了1227名患有活动性癌症的患者。随机临床试验的亚组分析和荟萃分析的初步结果表明，NOACs可能是活动性癌症患者传统抗凝治疗的替代方案。需要进一步开展“专门”研究，评估NOACs治疗VTE合并癌症患者的临床获益。
