癌症患者静脉血栓栓塞症抗凝治疗：新型口服抗凝剂与低分子肝素的对比——一项初步研究。
Extended treatment with non-vitamin K antagonist oral anticoagulants versus low-molecular-weight heparins in cancer patients following venous thromboembolism. A pilot study.
机构信息
Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, 80 Pradnicka Street, 31-202 Krakow, Poland.
Department of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7a Kopernika Street, 31-034 Krakow, Poland.
出版信息
Vascul Pharmacol. 2019 Sep;120:106567. doi: 10.1016/j.vph.2019.106567. Epub 2019 May 31.
BACKGROUND
Low-molecular-weight heparins (LMWH) are the drug of choice for treatment of cancer-associated thrombosis (CAT), however non-vitamin K antagonist oral anticoagulants (NOAC) seem to be a reasonable alternative. We investigated the safety and efficacy of NOAC versus LMWH in patients with a history of CAT.
METHODS
In a prospective cohort study 128 consecutive patients with active cancer who experienced CAT were enrolled following LMWH treatment for ≥3 months. Symptomatic recurrent venous thromboembolism (VTE), bleeding and death were recorded during follow-up.
RESULTS
65 (50.8%) patients were switched to NOAC and 63 (49.2%) continued with LMWH. During a median follow-up of 17 (interquartile range, 15-21) months, recurrent VTE was observed in 6 (9.2%) patients on NOAC and in 12 (19.0%) on LMWH (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.16-1.16). The rate of major bleeding was 9.2% and 4.8%, respectively (HR 2.00, 95% CI 0.50-8.00). The median time to bleeding was shorter in patients on NOAC (3 [2.25-5.5] months) versus on LMWH (9 [6.5-13.0] months). The mortality rates were similar in both groups (15.4% versus 15.9%, respectively, HR 0.76, 95% CI 0.32-1.84).
CONCLUSIONS
In patients following CAT, extended treatment with NOAC, compared with LMWH, appears to be associated with similar effectiveness and safety.
背景
低分子量肝素（LMWH）是治疗癌症相关血栓形成（CAT）的首选药物，然而，非维生素 K 拮抗剂口服抗凝剂（NOAC）似乎是一种合理的替代选择。我们研究了 CAT 病史患者中 NOAC 与 LMWH 的安全性和疗效。
方法
在一项前瞻性队列研究中，128 例接受 LMWH 治疗≥3 个月的活动性癌症患者发生 CAT 后，被纳入研究。在随访期间记录有症状的复发性静脉血栓栓塞症（VTE）、出血和死亡。
结果
65 例（50.8%）患者换用 NOAC，63 例（49.2%）继续使用 LMWH。在中位数为 17（四分位间距，15-21）个月的随访期间，NOAC 组有 6 例（9.2%）和 LMWH 组有 12 例（19.0%）发生复发性 VTE（风险比 [HR] 0.44，95%置信区间 [CI] 0.16-1.16）。大出血的发生率分别为 9.2%和 4.8%（HR 2.00，95%CI 0.50-8.00）。NOAC 组出血的中位时间短于 LMWH 组（3 [2.25-5.5]个月与 9 [6.5-13.0]个月）。两组死亡率相似（分别为 15.4%和 15.9%，HR 0.76，95%CI 0.32-1.84）。
结论
在 CAT 患者中，与 LMWH 相比，NOAC 的延长治疗似乎具有相似的有效性和安全性。
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