Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
Clinical Division of Haematology and Haemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Thromb Res. 2020 Jul;191 Suppl 1:S3-S11. doi: 10.1016/S0049-3848(20)30389-3.
Venous thromboembolism (VTE) is a preventable disease, thus, in a number of clinical situations primary thromboprophylaxis has been proposed. Although we now know that cancer is one of the most important risk factors for VTE, primary prophylactic anticoagulation is only widely established for high-risk hospitalized patients and peri- and postoperatively after major cancer surgery. Long-term primary thromboprophylaxis in ambulatory cancer patients has been demonstrated to be effective. However, drawbacks are the additional burden of drug use, the lack of a reduced mortality benefit and costs. Only with reliable risk prediction the recommendation of primary thromboprophylaxis will convince oncologists and patients of its usefulness. This review deals with clinical and laboratory parameters and their combination in risk assessment models to define patients at high and low risk of VTE, in whom targeted thromboprophylaxis could best be applied. At present 90% of patients in the so-called intermediate- to high-risk group according to the Khorana score still do not develop VTE during the first 6 months, whereas there is a high absolute number of patients in the so-called low-risk groups that develop VTE. Improvements in risk assessment have been made by new risk prediction models. However, additional refinements to further improve risk prediction and their applicability in clinical practice are still needed.
静脉血栓栓塞症（VTE）是一种可预防的疾病，因此，在许多临床情况下都提出了一级预防血栓形成。虽然我们现在知道癌症是 VTE 的最重要危险因素之一，但一级预防性抗凝治疗仅广泛应用于高危住院患者和重大癌症手术后的围手术期。已证明对门诊癌症患者进行长期一级预防血栓形成是有效的。然而，缺点是药物使用的额外负担、缺乏降低死亡率的益处和成本。只有通过可靠的风险预测，一级预防血栓形成的建议才能使肿瘤学家和患者相信其有用性。这篇综述涉及临床和实验室参数及其组合在风险评估模型中的应用，以确定处于高风险和低风险的 VTE 患者，靶向性预防血栓形成可以最好地应用于这些患者。目前，根据 Khorana 评分，所谓的中高危组的 90%的患者在头 6 个月内仍未发生 VTE，而所谓的低危组中发生 VTE 的患者数量却很高。通过新的风险预测模型，风险评估得到了改善。然而，仍需要进一步改进风险预测及其在临床实践中的适用性。
