Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Department of Medicine, London Health Sciences Centre, London, Canada.
Thromb Res. 2018 Mar;163:41-46. doi: 10.1016/j.thromres.2018.01.009. Epub 2018 Jan 9.
The risk of recurrent venous thromboembolism (VTE) in cancer patients despite anticoagulant therapy is high. Clinical factors and pro-coagulant markers may identify high-risk patients and guide decisions about intensifying anticoagulation therapy.
To evaluate whether serial measurements of pro-coagulant markers can identify patients at high risk of recurrent VTE.
In this multicenter, prospective cohort study, patients with active cancer and acute deep vein thrombosis or pulmonary embolism were enrolled. Patients received standard low-molecular-weight heparin therapy and were followed for 6 months. D-dimer and soluble P-selectin levels were measured at baseline and 1, 4, 5, 12, and 24 weeks post treatment initiation. The association between recurrent VTE and a previously developed risk score, baseline values of the biomarkers, and individual relative changes from baseline were assessed.
We enrolled 117 cancer patients (22% lung, 21% colorectal, 9% breast) with a mean age of 63 years; 62% had metastatic cancer. Eleven patients (9.4%) developed recurrent VTE, including two cases of fatal pulmonary embolism. VTE recurrence rates were 7.8% (95% CI, 3.1-18) in patients with a risk score of ≤0 points compared to 11% (95% CI, 5.2-20) for those with a score of ≥1 point (hazard ratio 1.3; 95% CI, 0.39-4.5). Baseline P-selectin levels but not D-dimer levels were significantly associated with a high risk of recurrence; the risk was four-fold higher in patients with elevated P-selectin levels than in those with normal levels (hazard ratio 4.0; 95% CI, 1.1-14). Changes in biomarker levels during treatment were not associated with recurrent VTE.
Baseline P-selectin but not D-dimer levels predict recurrent VTE and may be a valuable addition to clinical prediction rules to select patients for more intensive therapy or closer observation.
尽管接受抗凝治疗，癌症患者仍有发生静脉血栓栓塞（VTE）复发的高风险。临床因素和促凝标志物可识别高危患者，并指导强化抗凝治疗决策。
评估连续测量促凝标志物是否可识别 VTE 复发风险较高的患者。
在这项多中心前瞻性队列研究中，纳入患有活动性癌症并伴有急性深静脉血栓形成或肺栓塞的患者。患者接受标准低分子肝素治疗，并随访 6 个月。在治疗开始后第 1、4、5、12 和 24 周分别测量 D-二聚体和可溶性 P-选择素水平。评估 VTE 复发与之前开发的风险评分、生物标志物的基线值以及与基线相比的个体相对变化之间的关系。
我们纳入了 117 例癌症患者（22%为肺癌，21%为结直肠癌，9%为乳腺癌），平均年龄为 63 岁；62%患者有转移性癌症。11 例患者（9.4%）发生 VTE 复发，包括 2 例致命性肺栓塞。风险评分为≤0 分的患者 VTE 复发率为 7.8%（95%CI，3.1-18），评分≥1 分的患者为 11%（95%CI，5.2-20）（危险比 1.3；95%CI，0.39-4.5）。基线 P-选择素水平但不是 D-二聚体水平与高复发风险显著相关；P-选择素水平升高患者的风险是水平正常患者的 4 倍（危险比 4.0；95%CI，1.1-14）。治疗期间生物标志物水平的变化与 VTE 复发无关。
基线 P-选择素但不是 D-二聚体水平可预测 VTE 复发，可能是临床预测规则的有益补充，可选择更强化的治疗或更密切的观察。
