Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Thromb Res. 2020 Jul;191 Suppl 1:S123-S127. doi: 10.1016/S0049-3848(20)30409-6.
Approximately one-fifth of all cases of venous thromboembolism (VTE) are related to cancer. VTE complications may have a substantial impact on prognosis, quality of life and care in patients with cancer. Patients with cancer-related VTE are at increased risk of developing recurrent VTE compared to patients without cancer, but also have a higher risk of major bleeding. In the last years, direct oral anticoagulants (DOACs) have been evaluated in a head-to-head comparison with low molecular weight heparin (LMWH) in two randomized trials for the long-term treatment of VTE in patients with advanced cancer. The results of these trials show that DOACs have a similar efficacy profile, but probably higher risk of bleeding, compared to LMWH dalteparin. Because DOACs offer a simple oral treatment regimen without the need for anticoagulation monitoring, they could be attractive alternatives to LMWHs in these setting. The American Society of Clinical Oncology guidelines, published in August 2019, recommend LMWH, edoxaban and rivaroxaban as first-choice therapies for long-term anticoagulation in cancer patients with VTE. However, several practical issues should be considered concerning the long-term use of DOAC treatment in patients with cancer. Major concerns have been highlighted about the gastrointestinal bleeding risk in patients with gastrointestinal cancers and the potential drug-drug interactions in combination for some specific anticancer therapies. Several studies comparing DOACs with LMWH are currently ongoing to refine our knowledge concerning treatment with DOACs in patients with cancer-associated VTE.
大约五分之一的静脉血栓栓塞症（VTE）与癌症有关。VTE 并发症可能对癌症患者的预后、生活质量和护理产生重大影响。与无癌症患者相比，癌症相关 VTE 患者发生复发性 VTE 的风险增加，但大出血风险也更高。在过去几年中，直接口服抗凝剂（DOAC）已在两项随机试验中与低分子量肝素（LMWH）进行头对头比较，用于治疗晚期癌症患者的 VTE 长期治疗。这些试验的结果表明，与 LMWH 达肝素相比，DOAC 具有相似的疗效谱，但出血风险可能更高。由于 DOAC 提供了一种无需抗凝监测的简单口服治疗方案，因此它们可能是这些情况下 LMWH 的有吸引力的替代方案。2019 年 8 月发表的美国临床肿瘤学会指南建议，对于 VTE 癌症患者的长期抗凝治疗，低分子量肝素、依度沙班和利伐沙班作为首选治疗方法。然而，对于癌症患者长期使用 DOAC 治疗，需要考虑一些实际问题。人们对胃肠道癌症患者的胃肠道出血风险以及某些特定抗癌治疗联合使用时的潜在药物相互作用表示了严重关切。目前正在进行多项比较 DOAC 和 LMWH 的研究，以进一步了解 DOAC 在癌症相关 VTE 患者中的治疗。
