Department of Respiratory and Critical Care Medicine, The 74540First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
Vascular. 2021 Jun;29(3):408-414. doi: 10.1177/1708538120957443. Epub 2020 Sep 21.
Venous thromboembolism is a major cause of morbidity, mortality, and increased medical costs in tumor patients. In the current review, we summarize the progress made in the study of cancer-associated venous thromboembolism.
By searching cancer-associated venous thromboembolism-related literature on PubMed, the epidemiology, pathological mechanisms, risk factors, risk prediction models, and prevention and treatment of cancer-associated venous thromboembolism were reviewed.
The pathophysiological mechanisms of cancer-associated venous thromboembolism are multifactorial. Various blood cell counts (such as platelets and white blood cells) and biomarkers (such as D-dimer and sP-selectin) were considered predictors of thrombosis in cancer patients and were incorporated into the venous thromboembolism risk stratification models. Thromboprophylaxis is currently recommended for all hospitalized cancer patients. In addition, outpatient thromboprophylaxis can be used for selected high-risk patients. Low-molecular-weight heparin was the preferred treatment for cancer-associated venous thromboembolism, but some issues arose in the long-term treatment. In this case, direct oral anticoagulants were a treatment option for tumor patients. The efficacy of direct oral anticoagulant in treating cancer patients is not inferior to low-molecular-weight heparin, but is associated with a higher risk of bleeding. Therefore, there were concerns regarding their safety.
Since thrombocytopenia, thrombosis recurrence, and bleeding are common in tumor patients, the selection of anticoagulants in this circumstance is a considerable challenge for clinicians.
静脉血栓栓塞症是肿瘤患者发病率、死亡率和医疗费用增加的主要原因。在本综述中，我们总结了癌症相关静脉血栓栓塞症研究的进展。
通过在 PubMed 上搜索癌症相关静脉血栓栓塞症相关文献，回顾了癌症相关静脉血栓栓塞症的流行病学、病理机制、危险因素、风险预测模型以及预防和治疗。
癌症相关静脉血栓栓塞症的病理生理机制是多因素的。各种血细胞计数（如血小板和白细胞）和生物标志物（如 D-二聚体和 sP-选择素）被认为是癌症患者血栓形成的预测指标，并被纳入静脉血栓栓塞风险分层模型。目前建议对所有住院癌症患者进行血栓预防。此外，还可以对选定的高危患者进行门诊血栓预防。低分子肝素是癌症相关静脉血栓栓塞症的首选治疗方法，但在长期治疗中出现了一些问题。在这种情况下，直接口服抗凝剂是肿瘤患者的一种治疗选择。直接口服抗凝剂治疗癌症患者的疗效并不逊于低分子肝素，但与更高的出血风险相关。因此，人们对其安全性表示担忧。
由于肿瘤患者常出现血小板减少、血栓复发和出血，因此在这种情况下选择抗凝剂对临床医生来说是一个相当大的挑战。
