Mosaad Manar, Elnaem Mohamed Hassan, Cheema Ejaz, Ibrahim Ismail, Ab Rahman Jamalludin, Kori Ahlam Naila, Hin How Soon
Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Int J Gen Med. 2021 Jul 24;14:3881-3897. doi: 10.2147/IJGM.S320492. eCollection 2021.
Cancer-associated thrombosis (CAT) is a leading cause of death in cancer patients receiving outpatient chemotherapy. The latest guidelines emphasize stratifying the patients in terms of CAT risks periodically. Multiple risk assessment models (RAMs) were developed to classify patients and guide thromboprophylaxis to high-risk patients. This study aimed to discuss and highlight different RAMs across various malignancy types with their related advantages and disadvantages. A scoping review was conducted using predefined search terms in three scientific databases, including Google Scholar, Science Direct, and PubMed. The search for studies was restricted to original research articles that reported risk assessment models published in the last thirteen years (between 2008 and 2021) to cover the most recently published evidence following the development of the principal risk assessment score in 2008. Data charting of the relevant trials, scores, advantages, and disadvantages were done iteratively considering the malignancy type. Of the initially identified 1115 studies, 39 studies with over 67,680 patients were included in the review. In solid organ malignancy, nine risk assessment scores were generated. The first and most known Khorana risk score still offers the best available risk assessment model when used for high-risk populations with a threshold of 2 and above. However, KRS has a limitation of failure to stratify low-risk patients. The COMPASS-CAT score showed the best performance in the lung carcinoma patients who have a higher prevalence of thrombosis than other malignancy subtypes. In testicular germ cell tumours, Bezan et al RAM is a validated good discriminatory RAM for this malignancy subtype. CAT in haematological malignancy seems to be under-investigated and has multiple disease-related, and treatment-related confounding factors. AL-Ani et al score performed efficiently in acute leukemia. In multiple myeloma, both SAVED and IMPEDED VTE scores showed good performance. Despite the availability of different disease-specific scores in lymphoma-related thrombosis, the standard of care needs to be redefined.
癌症相关血栓形成（CAT）是接受门诊化疗的癌症患者的主要死因。最新指南强调定期根据CAT风险对患者进行分层。已开发出多种风险评估模型（RAM）来对患者进行分类，并指导对高危患者进行血栓预防。本研究旨在讨论并突出不同恶性肿瘤类型的不同RAM及其相关优缺点。使用预定义的搜索词在三个科学数据库（包括谷歌学术、科学Direct和PubMed）中进行了范围综述。研究搜索仅限于报告过去十三年（2008年至2021年）发表的风险评估模型的原创研究文章，以涵盖2008年主要风险评估评分制定后最新发表的证据。考虑到恶性肿瘤类型，对相关试验、评分、优点和缺点进行了反复的数据图表分析。在最初识别的1115项研究中，有39项研究纳入了超过67680名患者。在实体器官恶性肿瘤中，生成了九个风险评估评分。第一个也是最知名的科拉纳风险评分在用于阈值为2及以上的高危人群时，仍然提供了最佳的可用风险评估模型。然而，科拉纳风险评分存在无法对低风险患者进行分层的局限性。COMPASS-CAT评分在血栓形成患病率高于其他恶性肿瘤亚型的肺癌患者中表现最佳。在睾丸生殖细胞肿瘤中贝赞等人的RAM是针对该恶性肿瘤亚型经过验证的良好鉴别RAM。血液系统恶性肿瘤中的CAT似乎研究不足，并且有多种疾病相关和治疗相关的混杂因素。AL-Ani等人的评分在急性白血病中表现有效。在多发性骨髓瘤中，SAVED和IMPEDED VTE评分均表现良好。尽管在淋巴瘤相关血栓形成方面有不同的疾病特异性评分，但仍需要重新定义护理标准。
