Patel Harsh K, Khorana Alok A
Kansas City VA Medical Center, 4801 Linwood Blvd, Kansas City, MO, 64128, USA.
Taussig Cancer Institute, Cleveland Clinic, 10201 Carnegie Ave./CA60, Cleveland, OH, 44195, USA.
Curr Oncol Rep. 2019 Feb 4;21(2):18. doi: 10.1007/s11912-019-0767-5.
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients, and its management is often associated with complications including risk of recurrent VTE and bleeding. Here, we review the current data on pitfalls during anticoagulation in cancer patients and measures necessary to avoid them.
Although low-molecular-weight heparin monotherapy has been the standard of treatment for several years, emerging data for direct oral anticoagulants (DOACs) are leading to new paradigms in treatment. Reports of recent randomized trials suggest a lower risk of recurrent thrombosis but higher risk of bleeding, particularly in gastrointestinal cancer patients, with DOACs. Careful patient selection and individualization of therapy based on risk of bleeding as well as recurrent VTE are keys. Problems like bleeding, recurrence, thrombocytopenia, drug-drug interactions, renal impairment, nausea-vomiting along with concerns about adherence arise during anticoagulation in cancer patients. However, with adequate pre-treatment assessment, correct anticoagulant selection and proper monitoring during anticoagulation, these issues can be addressed safely and effectively.
静脉血栓栓塞症（VTE）是癌症患者发病和死亡的主要原因，其治疗通常会伴随包括复发性VTE和出血风险在内的并发症。在此，我们综述了癌症患者抗凝治疗过程中陷阱的当前数据以及避免这些陷阱所需的措施。
尽管低分子量肝素单药治疗多年来一直是治疗标准，但直接口服抗凝剂（DOACs）的新数据正在引领治疗新范式。近期随机试验报告表明，使用DOACs时复发性血栓形成风险较低，但出血风险较高，尤其是在胃肠道癌症患者中。基于出血风险以及复发性VTE进行仔细的患者选择和个体化治疗是关键。癌症患者抗凝治疗期间会出现出血、复发、血小板减少、药物相互作用、肾功能损害、恶心呕吐以及依从性问题等。然而，通过充分的预处理评估、正确的抗凝剂选择以及抗凝期间的适当监测，这些问题可以得到安全有效的解决。
