Panizo Elena, Alfonso Ana, García-Mouriz Alberto, López-Picazo José M, Gil-Bazo Ignacio, Hermida José, Páramo José A, Lecumberri Ramón
Hematology Service, University Clinic of Navarra, Pamplona, Spain.
Informatics Department, University Clinic of Navarra, Pamplona, Spain.
Thromb Res. 2015 Dec;136(6):1145-8. doi: 10.1016/j.thromres.2015.10.015. Epub 2015 Oct 9.
Current clinical practice guidelines do not recommend routine pharmacological thromboprophylaxis in cancer outpatients receiving chemotherapy. However, a high proportion of cancer-associated venous thromboembolism (VTE) events occur in this setting. There are scarce data on the use of thromboprophylaxis in ambulatory cancer patients in real clinical practice.
We conducted a single-center prospective study aimed to evaluate the use and factors influencing pharmacological prophylaxis in consecutive cancer patients receiving ambulatory chemotherapy. Patients were followed for 90 days after inclusion.
A total of 1108 patients were included. According to the Khorana score, 45.8% patients were classified as low-risk, 47.4% intermediate-risk and 6.8% as high-risk. Outpatient pharmacological prophylaxis was administered at any time during follow-up to 157 patients (14.2%) with a median duration of 42 days (range 1-90). Main factors influencing thromboprophylaxis were: previous history of VTE (odds ratio [OR], 19.11; 95% CI, 9.61-37.98), intercurrent hospitalization (OR, 5.40; 95% CI, 3.57-8.16), and gastrointestinal or gynecologic cancer (OR, 1.76; 95% CI, 1.11-2.80 and OR, 2.34; 95% CI, 1.05-5.26, respectively). During follow-up 58 (5.2%) VTE events were observed. Independent predictors of VTE were the site of malignancy (OR, 3.04; 95%CI, 1.20-7.71 and OR, 2.47; 95%CI, 1.21-5.01 for pancreas and lung cancer, respectively) and previous VTE (OR, 4.23; 95%CI, 1.26-14.27). Outpatient prophylaxis was associated with a lower risk of VTE during follow-up (OR, 0.30; 95%CI, 0.10-0.95).
Although the type of malignancy appears as the most relevant variable for decision-making, additional efforts are required to identify patients at particular high thrombosis risk.
当前临床实践指南不建议对接受化疗的癌症门诊患者进行常规药物性血栓预防。然而，在这种情况下，相当一部分癌症相关的静脉血栓栓塞（VTE）事件仍会发生。关于在实际临床实践中对门诊癌症患者使用血栓预防措施的数据很少。
我们进行了一项单中心前瞻性研究，旨在评估连续接受门诊化疗的癌症患者使用药物预防的情况及其影响因素。患者纳入后随访90天。
共纳入1108例患者。根据Khorana评分，45.8%的患者被归类为低风险，47.4%为中度风险，6.8%为高风险。在随访期间，157例患者（14.2%）在任何时间接受了门诊药物预防，中位持续时间为42天（范围1 - 90天）。影响血栓预防的主要因素有：既往VTE病史（比值比[OR]，19.11；95%置信区间[CI]，9.61 - 37.98）、并发住院（OR，5.40；95%CI，3.57 - 8.16）以及胃肠道或妇科癌症（OR分别为1.76；95%CI，1.11 - 2.80和OR，2.34；95%CI，1.05 - 5.26）。随访期间观察到58例（5.2%）VTE事件。VTE的独立预测因素为恶性肿瘤部位（OR分别为3.04；95%CI，1.20 - 7.71和OR，2.47；95%CI，1.21 - 5.01，分别针对胰腺癌和肺癌）以及既往VTE（OR，4.23；95%CI，1.26 - 14.27）。门诊预防与随访期间较低的VTE风险相关（OR，0.30；95%CI，0.10 - 0.95）。
尽管恶性肿瘤类型似乎是决策中最相关的变量，但仍需要进一步努力来识别具有特别高血栓形成风险的患者。
