Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2019 Feb 1;34(6):e52. doi: 10.3346/jkms.2019.34.e52. eCollection 2019 Feb 18.
Cancer-associated venous thromboembolism (CAT) is a common complication associated with high morbidity and mortality. In accordance with major clinical trials comparing low-molecular-weight heparin (LMWH) with a vitamin K antagonist (VKA), LMWH is currently the standard treatment for CAT, owing to its efficacy for thrombosis recurrence and improved safety profile compared to VKA. Over the past few years, direct oral anticoagulants (DOACs) have emerged as potential alternative therapies to LMWH due to their convenient route of administration and predictable pharmacokinetics, but evidence for their use in CAT is inconclusive, as only a small fraction of the study populations in these trials had CAT. Recently, two large head-to-head trials comparing DOACs to LMWH in CAT patients reported comparable efficacies of DOACs with increased bleeding risk. Occasionally, CAT treatment can be challenging due to the heterogeneity of underlying malignancies and comorbidities. Renal insufficiency and gastrointestinal defects are the main obstacles in anticoagulant selection. Careful choice of treatment candidates and proper anticoagulant strategies are critical for the treatment of CAT; hence, more studies are required to address these challenges.
癌症相关静脉血栓栓塞症（CAT）是一种常见的并发症，与高发病率和死亡率相关。根据比较低分子量肝素（LMWH）与维生素 K 拮抗剂（VKA）的主要临床试验，LMWH 目前是 CAT 的标准治疗方法，因为与 VKA 相比，它在血栓复发方面更有效，安全性更好。在过去几年中，直接口服抗凝剂（DOACs）由于其给药途径方便和药代动力学可预测，已成为 LMWH 的潜在替代治疗方法，但在 CAT 中的使用证据尚无定论，因为这些试验的研究人群中只有一小部分患有 CAT。最近，两项比较 CAT 患者中 DOACs 与 LMWH 的头对头大型试验报告称，DOACs 的疗效相当，但出血风险增加。偶尔，由于潜在恶性肿瘤和合并症的异质性，CAT 治疗可能具有挑战性。肾功能不全和胃肠道缺陷是抗凝剂选择的主要障碍。仔细选择治疗候选者和适当的抗凝策略对于 CAT 的治疗至关重要；因此，需要进一步研究来解决这些挑战。
