Ibrahim Rami B, Skewes Michelle D, Kuriakose Philip
aDepartment of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University bSchool of Medicine, Wayne State University cCollege of Osteopathic Medicine, Michigan State University dDivision of Hematology/Oncology, Department of Internal Medicine, Henry Ford Hospital/Josephine Ford Cancer Center eSchool of Medicine, Wayne State University Medical School, Detroit, Michigan, USA.
Blood Coagul Fibrinolysis. 2016 Sep;27(6):615-30. doi: 10.1097/MBC.0000000000000539.
Simply providing anticoagulation therapy is not as straightforward of a solution in cancer patients who have concurrent thrombocytopenia owing to the increased risk of bleeding complications. Currently, few guidelines are in place to assist clinicians in safely managing thrombocytopenic cancer patients on anticoagulation. The purpose of this review is to critically examine the available body of biomedical literature surrounding anticoagulant use against the backdrop of cancer-related thrombocytopenia in adult patients. Available evidence for the use of parenteral anticoagulants (low molecular weight heparins, unfractionated heparin, pentasaccharides, and direct thrombin inhibitors) and oral anticoagulants (vitamin K antagonists and novel oral anticoagulants) in thrombocytopenic cancer patients is described. The review revealed many inconsistencies between reports on this topic, which made it difficult to draw firm conclusions as to, for example, the ideal well tolerated anticoagulant dose in thrombocytopenic cancer patients? Intriguingly, critical clinical information including (but not limited) patient platelet nadirs, platelet counts during bleeding episodes, and platelet transfusion support was absent from a not-so-insignificant number of publications. Despite these shortcomings, the review sets out to formulate recommendations on the management of anticoagulation, at prophylactic or treatment doses, in adult cancer patients who also have concurrent thrombocytopenia. It also enlists a call for the medical community, by mapping select clinical guideposts, for further research in this setting. With the inclusion of these criteria in future studies, only then formal recommendations on the ideal safe dosage of anticoagulants in cancer patients, based on solid evidence, are conceived.
对于同时患有血小板减少症的癌症患者，单纯提供抗凝治疗并非如此简单直接的解决方案，因为出血并发症的风险增加。目前，几乎没有指南可协助临床医生安全地管理接受抗凝治疗的血小板减少症癌症患者。本综述的目的是在成年患者癌症相关血小板减少症的背景下，严格审查围绕抗凝剂使用的现有生物医学文献。描述了在血小板减少症癌症患者中使用胃肠外抗凝剂（低分子量肝素、普通肝素、戊糖和直接凝血酶抑制剂）和口服抗凝剂（维生素K拮抗剂和新型口服抗凝剂）的现有证据。该综述揭示了关于该主题的报告之间存在许多不一致之处，这使得难以就例如血小板减少症癌症患者理想的耐受性良好的抗凝剂剂量等问题得出确凿结论。有趣的是，相当数量的出版物中缺少关键临床信息，包括（但不限于）患者血小板最低点、出血发作期间的血小板计数以及血小板输注支持。尽管存在这些缺点，本综述仍着手就同时患有血小板减少症的成年癌症患者预防性或治疗性剂量的抗凝管理制定建议。它还通过绘制选定的临床路标呼吁医学界在这种情况下进行进一步研究。只有在未来的研究中纳入这些标准，才有可能基于确凿证据就癌症患者抗凝剂的理想安全剂量提出正式建议。
