Tsoukalas Nikolaos, Papakotoulas Pavlos, Christopoulou Athina, Ardavanis Alexandros, Koumakis Georgios, Papandreou Christos, Papatsimpas Georgios, Papakostas Pavlos, Samelis Georgios, Andreadis Charalambos, Aravantinos Gerasimos, Ziras Nikolaos, Kalofonos Charalambos, Samantas Epameinondas, Souggleri Maria, Makrantonakis Paris, Pentheroudakis Georgios, Athanasiadis Athanasios, Stergiou Helen, Tripodaki Elli-Sofia, Bokas Alexandros, Grivas Anastasios, Timotheadou Eleni, Bournakis Evangelos, Varthalitis Ioannis, Boukovinas Ioannis
401 General Military Hospital, 11525 Athens, Greece.
"Theagenio" Anticancer Hospital, 54639 Thessaloniki, Greece.
Cancers (Basel). 2020 Jul 15;12(7):1907. doi: 10.3390/cancers12071907.
Cancer patients are at high risk for cancer-associated thrombosis (CAT). CAT is the second leading cause of death in these patients but it can be preventable with thromboprophylaxis. An observational, prospective, multicenter study aiming to record CAT management in clinical practice was conducted by the Hellenic Society of Medical Oncology (HeSMO). A total of 426 active cancer patients (mean age 65.3 years, mean BMI: 26.1 kg/m) who received thromboprophylaxis, were included from 18 oncology units. Tumor types were lung 25.1%, pancreas 13.9%, breast 8.7%, stomach 8.5%, ovarian 7.8%, and others 36%, while 69% had metastases. A total of 71% had a Khorana score ≤2 and 61% received High Thrombotic Risk Chemotherapy Agents (HTRCAs, e.g., platinum). For thromboprophylaxis patients received mainly Low Molecular Weight Heparins (LMWHs), on higher than prophylactic doses in 50% of cases. Overall, 16 (3.8%) thrombotic events and 6 (1.4%) bleeding events were recorded. Notably, patients on higher doses of LMWHs compared to patients who received standard prophylactic doses had 70% lower odds to develop thrombotic events (OR: 0.3, 95% CI: 0.10-1.0, = 0.04). CAT is an important issue in oncology. Along with the Khorana score, factors as metastasis and use of HTRCAs should also be taken into consideration. Thromboprophylaxis for active cancer patients with LMWHs, even on higher doses is safe and efficient.
癌症患者发生癌症相关血栓形成（CAT）的风险很高。CAT是这些患者的第二大死因，但通过血栓预防是可以预防的。希腊医学肿瘤学会（HeSMO）开展了一项观察性、前瞻性、多中心研究，旨在记录临床实践中CAT的管理情况。来自18个肿瘤科室的426例接受血栓预防的活跃癌症患者（平均年龄65.3岁，平均体重指数：26.1kg/m）被纳入研究。肿瘤类型包括肺癌25.1%、胰腺癌13.9%、乳腺癌8.7%、胃癌8.5%、卵巢癌7.8%，其他为36%，69%的患者有转移。共有71%的患者Khorana评分≤2，61%的患者接受高血栓风险化疗药物（HTRCAs，如铂类）。对于血栓预防，患者主要接受低分子量肝素（LMWHs），50%的病例使用高于预防剂量的LMWHs。总体而言，记录到16例（3.8%）血栓事件和6例（1.4%）出血事件。值得注意的是，与接受标准预防剂量的患者相比，接受高剂量LMWHs的患者发生血栓事件的几率低70%（比值比：0.3，95%置信区间：0.10-1.0，P=0.04）。CAT是肿瘤学中的一个重要问题。除了Khorana评分外，转移和HTRCAs的使用等因素也应予以考虑。对活跃癌症患者使用LMWHs进行血栓预防，即使是高剂量也是安全有效的。
