Dimakakos Evangelos P, Vathiotis Ioannis, Syrigos Konstantinos
1 Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece.
Clin Appl Thromb Hemost. 2018 Jul;24(5):697-707. doi: 10.1177/1076029617729215. Epub 2017 Oct 31.
Current guidelines recommend low-molecular-weight heparin treatment in patients with cancer with established venous thromboembolism (VTE). The aim of this article was to study the pharmacological properties and effectiveness of tinzaparin in patients with cancer as well as its potential anticancer properties. A search of PubMed and ScienceDirect databases up to March 2016 was carried out to identify published studies that detect the properties and use of tinzaparin in oncology. Protamine sulfate partially (60% to 65%) neutralized tinzaparin's anti-Xa activity. No dose adjustment of tinzaparin is needed even in patients with severe renal impairment and Creatinine Clearance ≥20 mL/min. Tinzaparin demonstrated a statistically significant decline in VTE recurrence at 1 year post the index thromboembolic event. A statistically significant reduction in minor bleeding rates was also described, whereas major bleeding events did not decrease in patients with cancer treated with tinzaparin versus those who received vitamin K antagonists. Tinzaparin treatment in patients suffering from deep vein thrombosis reduced the incidence of postthrombotic syndrome and venous ulcers. Tinzaparin's ability to prevent both metastatic dissemination of cancer cells and tumor angiogenesis has been delineated in preclinical research. Current data show that tinzaparin is safe and efficacious either for short-term or for long-term treatment of VTE in patients with cancer. Clinical trials are needed in order to examine the utility of tinzaparin in primary prevention of VTE and validate its potential anticancer advantages exhibited in preclinical research.
当前指南推荐对已确诊静脉血栓栓塞症(VTE)的癌症患者采用低分子量肝素治疗。本文旨在研究替扎肝素在癌症患者中的药理特性和有效性及其潜在的抗癌特性。检索截至2016年3月的PubMed和ScienceDirect数据库,以识别已发表的检测替扎肝素在肿瘤学中的特性和用途的研究。硫酸鱼精蛋白可部分(60%至65%)中和替扎肝素的抗Xa活性。即使是严重肾功能不全且肌酐清除率≥20 mL/min的患者也无需调整替扎肝素剂量。在首次血栓栓塞事件发生后1年,替扎肝素使VTE复发率出现统计学显著下降。还发现轻微出血率有统计学显著降低,而与接受维生素K拮抗剂治疗的癌症患者相比,接受替扎肝素治疗的患者严重出血事件并未减少。替扎肝素治疗深静脉血栓形成患者可降低血栓形成后综合征和静脉溃疡的发生率。临床前研究已阐明替扎肝素预防癌细胞转移扩散和肿瘤血管生成的能力。目前数据表明,替扎肝素在癌症患者VTE的短期或长期治疗中均安全有效。需要进行临床试验,以检验替扎肝素在VTE一级预防中的效用,并验证其在临床前研究中展现出的潜在抗癌优势。