Debourdeau Philippe, Cossou-Gbeto Cresent, Takam-Sohwe Thierry, Laroche Jean-Pierre
Institut Sainte Catherine, unité des soins de support, 250, chemin de Baigne-Pieds CS 80005, 84918 Avignon cedex 9, France.
Hôpital Henri-Duffaut, service d'oncologie-hématologie, 305, rue Raoul-Follereau, 84000 Avignon cedex 9, France.
Bull Cancer. 2020 Feb;107(2):224-233. doi: 10.1016/j.bulcan.2019.11.007. Epub 2020 Jan 28.
According to international clinical practice guidelines, low-molecular-weight heparins are advocate for the treatment and the prevention of cancer associated thrombosis. Direct oral anticoagulants recently introduced represent an alternative to vitamin K antagonists and low-molecular-weight heparins since their use doesn't require coagulation monitoring or daily subcutaneous injections. Recent studies comparing direct oral anticoagulants and low-molecular-weight heparins have shown a trend towards a reduction of venous thromboembolism events of direct oral anticoagulants but an increased risk of major bleeding. Recent French inter-group recommendations on the treatment of venous thromboembolism in cancer patients, favor low molecular weight heparins over direct oral anticoagulants as curative agents. In the light of recent studies, the objective of this review is to re-evaluate the place of low-molecular-weight heparins in the management of patents with cancer-associated thrombosis and to focus on the recent updates of international guidelines.
根据国际临床实践指南，低分子量肝素被推荐用于治疗和预防癌症相关血栓形成。最近引入的直接口服抗凝剂是维生素K拮抗剂和低分子量肝素的替代品，因为其使用不需要凝血监测或每日皮下注射。最近比较直接口服抗凝剂和低分子量肝素的研究表明，直接口服抗凝剂有降低静脉血栓栓塞事件的趋势，但大出血风险增加。法国最近关于癌症患者静脉血栓栓塞治疗的组间建议，更倾向于使用低分子量肝素而非直接口服抗凝剂作为治疗药物。鉴于最近的研究，本综述的目的是重新评估低分子量肝素在癌症相关血栓形成患者管理中的地位，并关注国际指南的最新更新。
