Agnelli Giancarlo, Muñoz Andrés, Franco Laura, Mahé Isabelle, Brenner Benjamin, Connors Jean M, Gussoni Gualberto, Hamulyak Eva N, Lambert Catherine, Suero Maria Rosales, Bauersachs Rupert, Torbicki Adam, Becattini Cecilia
Internal Vascular and Emergency Medicine, University of Perugia, Perugia, Italy.
Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
Thromb Haemost. 2022 May;122(5):796-807. doi: 10.1055/s-0041-1735194. Epub 2021 Sep 16.
Efficacy and safety of anticoagulant treatment for venous thromboembolism (VTE) may vary in patients with different cancer sites. We evaluated the rates of VTE recurrence and major bleeding and the relative efficacy and safety of 6-month treatment with oral apixaban or subcutaneous dalteparin in patients with different cancer sites randomized in the Caravaggio study. Primary cancer was located at gastrointestinal sites in 375 patients (32.5%), lung in 200 (17.3%), breast in 155 (13.4%), genitourinary sites in 139 (12%), gynecological sites in 119 (10.3%), and was hematological in 85 patients (7.4%). Rates of VTE recurrence were 10.9% in patients with gynecological, 8.8% with gastrointestinal, 6.5% with genitourinary, and 5.5% with lung cancer with lower rates in the other sites of cancer. Rates of major bleeding were 7.2% in patients with genitourinary and 4.8% with gastrointestinal cancer, with lower rates in patients with other sites of cancer. The observed absolute risk difference in VTE recurrence in favor of apixaban was 11.9% in patients with gynecological, 5.5% with lung, 3.7% with genitourinary cancer, and 0.6% with gastrointestinal cancer. None of the risk differences was statistically significant. The rates of major bleeding in patients treated with apixaban or dalteparin was similar across patients with different cancer sites. In conclusion, recurrences appear to be more common in patients with gastrointestinal and gynecological cancer and major bleedings in patients with genitourinary and gastrointestinal cancer. Oral apixaban is a valid oral alternative to subcutaneous dalteparin for the treatment of a large spectrum of patients with cancer-associated VTE.
不同癌症部位的患者接受抗凝治疗以预防静脉血栓栓塞（VTE）的疗效和安全性可能有所不同。我们在卡拉瓦乔研究中评估了随机分组的不同癌症部位患者接受6个月口服阿哌沙班或皮下注射达肝素治疗后的VTE复发率、大出血发生率以及相对疗效和安全性。原发性癌症位于胃肠道部位的患者有375例（32.5%），肺部的有200例（17.3%），乳腺的有155例（13.4%），泌尿生殖系统部位的有139例（12%），妇科部位的有119例（10.3%），血液系统的有85例（7.4%）。妇科癌症患者的VTE复发率为10.9%，胃肠道癌症患者为8.8%，泌尿生殖系统癌症患者为6.5%，肺癌患者为5.5%，其他癌症部位的复发率较低。泌尿生殖系统癌症患者的大出血发生率为7.2%，胃肠道癌症患者为4.8%，其他癌症部位患者的发生率较低。在VTE复发方面，观察到阿哌沙班相对于达肝素的绝对风险差异在妇科癌症患者中为11.9%，肺癌患者中为5.5%，泌尿生殖系统癌症患者中为3.7%，胃肠道癌症患者中为0.6%。这些风险差异均无统计学意义。不同癌症部位的患者接受阿哌沙班或达肝素治疗后的大出血发生率相似。总之，胃肠道和妇科癌症患者的复发似乎更为常见，泌尿生殖系统和胃肠道癌症患者的大出血更为常见。口服阿哌沙班是皮下注射达肝素治疗广泛癌症相关VTE患者的一种有效的口服替代药物。
