Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/mvaduganathan.
J Am Coll Cardiol. 2019 Mar 26;73(11):1336-1349. doi: 10.1016/j.jacc.2019.01.017.
Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke prevention in patients with atrial fibrillation (AF). More recently, direct oral anticoagulants (DOACs) have been demonstrated to reduce the risk of venous and arterial thromboembolism in large randomized clinical trials of patients with VTE and AF, respectively, thus providing an attractive oral dosing option that does not require routine laboratory monitoring. In this review, we summarize available clinical trial data and guideline recommendations, and outline a practical approach to anticoagulation management of VTE and AF in cancer.
患有活动性癌症的患者发生动脉和静脉血栓栓塞症（VTE）和出血事件的风险增加。从历史上看，在癌症患者中，低分子肝素已被优选用于治疗 VTE，而华法林则是预防心房颤动（AF）患者中风的标准抗凝剂。最近，直接口服抗凝剂（DOAC）已在 VTE 和 AF 患者的大型随机临床试验中分别证明可降低静脉和动脉血栓栓塞的风险，从而提供了一种有吸引力的口服给药选择，无需常规实验室监测。在这篇综述中，我们总结了可用的临床试验数据和指南建议，并概述了癌症患者 VTE 和 AF 的抗凝管理的实用方法。
