Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Semin Thromb Hemost. 2021 Mar;47(2):139-149. doi: 10.1055/s-0041-1722863. Epub 2021 Feb 26.
The association between cancer and venous thromboembolism (VTE) has been established for more than 150 years. Nevertheless, cancer-associated thrombosis still remains a major clinical challenge and is associated with significant morbidity and mortality for patients with cancer. The clinical presentation of cancer-associated thrombosis can be distinct from that of a patient without an underlying malignancy. Moreover, specific cancer types, including pancreatic cancer and hematological malignancies, as well as advanced stage disease can confer a significant thrombotic risk. This risk is further augmented by specific anticancer treatment modalities. The pathophysiology of cancer-associated thrombosis is complex and multifactorial. However, understanding the biological mechanisms underpinning VTE risk may provide insight into novel targeted prophylaxis in cancer patients. Over the last decade, low-molecular-weight heparin has been the preferred anticoagulant agent for patients with cancer-associated thrombosis due to improved efficacy compared with vitamin K antagonists. However, the advent of direct oral anticoagulants (DOACs) has added to the repertoire of ammunition now at the disposal of clinicians to aid in the management of cancer-associated thrombosis. Several randomized controlled trials have now been published, demonstrating DOAC as a noninferior alternative for both the treatment and prevention of cancer-associated thrombosis. Notwithstanding this, limitations for their widespread use remain, with the potential for increased bleeding risk, drug interactions, and poor DOAC metabolism. This review discusses the evidence base for the incidence and risk factors associated with VTE in cancer, development, and refinement of risk prediction models and novel advances in the therapeutic management of cancer-associated thrombosis.
癌症与静脉血栓栓塞症（VTE）的关联已确立超过 150 年。然而，癌症相关血栓仍然是一个主要的临床挑战，与癌症患者的发病率和死亡率显著相关。癌症相关血栓的临床表现可能与无潜在恶性肿瘤的患者不同。此外，特定的癌症类型，包括胰腺癌和血液恶性肿瘤，以及晚期疾病，可带来显著的血栓风险。特定的抗癌治疗方式进一步增加了这种风险。癌症相关血栓形成的病理生理学是复杂的和多因素的。然而，了解 VTE 风险背后的生物学机制可能为癌症患者的新型靶向预防提供深入了解。在过去十年中，由于与维生素 K 拮抗剂相比具有更好的疗效，低分子量肝素已成为癌症相关血栓患者的首选抗凝剂。然而，直接口服抗凝剂（DOAC）的出现增加了临床医生可用于辅助管理癌症相关血栓的武器库。现在已经发表了几项随机对照试验，证明 DOAC 可作为癌症相关血栓的治疗和预防的非劣效替代方案。尽管如此，它们的广泛应用仍然存在局限性，包括出血风险增加、药物相互作用和 DOAC 代谢不良。这篇综述讨论了癌症相关 VTE 的发生率和风险因素的证据基础、风险预测模型的发展和完善以及癌症相关血栓治疗管理的新进展。
