Palliative Care Service, National Cancer Institute, Mexico City, Mexico.
Hematology Service, National Cancer Institute, Mexico City, Mexico.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221081121. doi: 10.1177/10760296221081121.
The prevalence of venous thromboembolism (VTE) in patients with cancer is particularly high at disease progression and during relapse. Patients cared for in specialized palliative care units (SPCU) are rarely included in VTE studies. Objective: We sought to study the prevalence, clinical characteristics, and survival of individuals with VTE in an SPCU setting.
We retrospectively included 2707 consecutive individuals with active cancer managed at a SPCU. Data were summarized using descriptive statistics and frequency for categorical variables. Overall survival was estimated by Kaplan-Meier and comparisons by log-rank test. Thrombotic events were confirmed by imaging.
We studied 1984(73.3%) women and 723 (26.7%) men. The overall prevalence of thrombosis was 22.2% with only 6.2% occurring after initiating SPCU care, and was higher in women (24.6% vs 15.8%), particularly with gynecological tumors (cervical: 30.5%, ovarian: 29.2%). Median survival was slightly longer for patients without VTE (80 days [IQR21-334] and 69 days [IQR 25-235]; p = 0.03).
Prevalence of VTE was high and varied by tumor origin. VTE may impact survival. Though median survival is short, some patients are followed over months, suggesting that in the absence of high bleeding risk, treatment for thrombosis in an attempt to decrease the morbidity of re-thrombosis should be considered. On the other hand, few patients developed symptomatic VTE during SPCU care, making generalized primary prophylaxis probably unwarranted. Customizing anticoagulation for the risk of hemorrhage and physical performance is essential.
癌症患者的静脉血栓栓塞症（VTE）在疾病进展和复发时尤其高发。在专门的姑息治疗病房（SPCU）接受治疗的患者很少被纳入 VTE 研究。目的：我们旨在研究 SPCU 环境中 VTE 患者的患病率、临床特征和生存率。
我们回顾性纳入了在 SPCU 接受治疗的 2707 例活动期癌症患者。使用描述性统计和分类变量的频率进行数据总结。使用 Kaplan-Meier 估计总体生存率，并通过对数秩检验进行比较。通过影像学确认血栓事件。
我们研究了 1984 名（73.3%）女性和 723 名（26.7%）男性。总体血栓形成患病率为 22.2%，仅有 6.2%发生在开始 SPCU 护理后，女性（24.6%比 15.8%）更高，特别是妇科肿瘤（宫颈癌：30.5%，卵巢癌：29.2%）。无 VTE 患者的中位生存期略长（80 天[IQR21-334]和 69 天[IQR 25-235]；p=0.03）。
VTE 的患病率较高，且与肿瘤来源有关。VTE 可能影响生存。尽管中位生存期较短，但一些患者随访数月，表明在没有高出血风险的情况下，应考虑为降低再血栓形成的发病率而进行血栓治疗。另一方面，在 SPCU 护理期间，很少有患者发生有症状的 VTE，因此广泛应用一级预防可能是不必要的。根据出血风险和身体表现定制抗凝治疗至关重要。
