Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Int J Gynaecol Obstet. 2019 Nov;147(2):252-257. doi: 10.1002/ijgo.12944. Epub 2019 Aug 29.
To retrospectively review the efficacy and safety of novel direct oral anticoagulants (DOACs) and compare the results with those of vitamin K antagonists (VKA) when used in clinical practice to treat venous thromboembolism (VTE) because there is insufficient evidence regarding its use in patients with gynecological cancers.
A study was conducted of patients diagnosed with gynecological cancers at Osaka University Hospital between January 2010 and December 2017. The medical records of those who suffered from deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were retrospectively reviewed.
Among the 1698 cases of gynecological cancers, 107 (6.3%) cases were diagnosed as having VTE. A total of 34 (31.8%) patients presented DVT plus PE and 73 (68.2%) patients had DVT alone. Fifty-four cases were treated with DOACs and 53 with VKA. Although 3 of the 53 patients (5.7%) in the VKA group developed recurrent VTE, only 1 (1.9%) patient in the DOAC group showed clinically relevant bleeding from a tumor penetrating the rectum. DOACs were non-inferior to VKA with respect to the composite outcome, including recurrent venous thrombosis and relevant bleeding (hazard ratio 0.31, 95% confidence interval 0.03-3.12, P=0.363).
DOACs can be effectively and safely used in VTE patients with gynecological cancers.
回顾新型口服抗凝剂（DOAC）治疗静脉血栓栓塞症（VTE）的疗效和安全性，并与维生素 K 拮抗剂（VKA）进行比较，因为在妇科癌症患者中使用 DOAC 的证据不足。
对 2010 年 1 月至 2017 年 12 月在大阪大学医院就诊的妇科癌症患者进行了一项研究。回顾了患有深静脉血栓形成（DVT）和/或肺栓塞（PE）的患者的病历。
在 1698 例妇科癌症患者中，107 例（6.3%）被诊断为 VTE。共有 34 例（31.8%）患者同时出现 DVT 和 PE，73 例（68.2%）患者仅出现 DVT。54 例患者接受 DOAC 治疗，53 例患者接受 VKA 治疗。虽然 VKA 组 53 例患者中有 3 例（5.7%）出现复发性 VTE，但仅 DOAC 组 1 例（1.9%）患者出现肿瘤穿透直肠相关的明显出血。DOAC 与 VKA 相比，在包括复发性静脉血栓形成和相关出血在内的复合结局方面无显著差异（风险比 0.31，95%置信区间 0.03-3.12，P=0.363）。
DOAC 可有效且安全地用于妇科癌症合并 VTE 的患者。
