Krasiński Zbigniew, Krasińska Beata, Dzieciuchowicz Łukasz, Urbanek Tomasz, Gabriel Marcin
Pol Arch Med Wewn. 2016 Jun 23;126(6):419-29. doi: 10.20452/pamw.3449.
A close causal relationship between cancer and venous thrombosis gives rise to questions about the effect of treatment modalities, in particular of the administered drugs, in patients with cancer-related venous thrombosis. An increased risk of chemotherapy-associated venous thromboembolism (VTE) has been well documented, while the effect of heparins used in VTE treatment on the disease course and prognosis in cancer patients has not been fully elucidated. This paper discusses the outcomes of the studies conducted so far investigating the role of heparins, in particular, low-molecular-weight heparins (LMWHs), in the prevention of thrombosis in cancer patients. It also focuses on such aspects of the treatment for cancer-associated VTE as treatment duration and drugs used. The paper summarizes the often discrepant results of long-term therapies with various LMWH products, emphasising that in this specific case the class effect is rather unlikely. It also presents the possible effects of heparins administered as part of cancer treatment, and points to the effects of LMWHs on cancer that are not related to an antithrombotic effect. On the 100th anniversary of heparin discovery, it can be said that heparin is irreversibly connected with thrombosis in the course of cancer.
癌症与静脉血栓形成之间存在密切的因果关系，这引发了关于治疗方式，尤其是所使用药物，对癌症相关静脉血栓形成患者影响的问题。化疗相关静脉血栓栓塞（VTE）风险增加已有充分记录，而用于VTE治疗的肝素对癌症患者病程和预后的影响尚未完全阐明。本文讨论了迄今为止所开展的研究结果，这些研究调查了肝素，特别是低分子肝素（LMWH）在预防癌症患者血栓形成中的作用。它还关注癌症相关VTE治疗的诸如治疗持续时间和所用药物等方面。本文总结了使用各种LMWH产品进行长期治疗时常常相互矛盾的结果，强调在这种特定情况下，类效应相当不可能存在。它还介绍了作为癌症治疗一部分给予肝素的可能效果，并指出LMWH对癌症的影响并非与抗血栓作用相关。在肝素发现100周年之际，可以说肝素在癌症病程中与血栓形成不可分割地联系在一起。
