Htut Thura Win, Thein Kyaw Zin, Oo Thein Hlaing
Department of Hematology, Aberdeen Royal Infirmary, University of Aberdeen, NHS Grampian, Scotland, UK.
Division of Hematology and Medical Oncology, Oregon Health and Science University/Knight Cancer Institute, Portland, Oregon.
Proc (Bayl Univ Med Cent). 2022 Feb 2;35(3):332-336. doi: 10.1080/08998280.2022.2026187. eCollection 2022.
Ovarian cancer (OC) is highly associated with venous thromboembolism (VTE). The OC cells stimulate thrombin generation, and chemotherapy potentiates the prothrombotic effect of cancer cells by damaging endothelium and enhancing hypercoagulability. Recently, primary ambulatory thromboprophylaxis (PATP) has been studied as a potential treatment in cancer patients undergoing chemotherapy with an aim of reducing the incidence of VTE and potentially prolonging survival. A meta-analysis was performed of randomized controlled trials of PATP vs control in patients with OC receiving chemotherapy. The primary outcome measure was the incidence of VTE. The secondary outcome measure was the incidence of major bleeding complications. Two articles published between 2012 and 2020 fulfilled selection criteria. The incidence of VTE was 0.9% in the PATP group and 1.8% in the control group. However, the pooled risk ratio was not statistically significant at 0.69 (95% CI: 0.08 to 5.67; = 0.73). The absolute risk difference was -0.03 (95% CI, -0.17 to 0.11; = 0.66). There was no statistically significant reduction in VTE by providing PATP to patients with OC receiving chemotherapy. Routine PATP should not be recommended in ambulatory OC patients. Future randomized trials are necessary to define the high-risk subset of OC patients who may benefit from PATP.
卵巢癌（OC）与静脉血栓栓塞症（VTE）高度相关。OC细胞刺激凝血酶生成，而化疗通过损伤内皮和增强高凝状态来增强癌细胞的促血栓形成作用。最近，初级门诊血栓预防（PATP）已作为接受化疗的癌症患者的一种潜在治疗方法进行研究，目的是降低VTE的发生率并可能延长生存期。对接受化疗的OC患者中PATP与对照组的随机对照试验进行了荟萃分析。主要结局指标是VTE的发生率。次要结局指标是大出血并发症的发生率。2012年至2020年间发表的两篇文章符合入选标准。PATP组VTE的发生率为0.9%，对照组为1.8%。然而，汇总风险比为0.69，无统计学意义（95%CI：0.08至5.67；P = 0.73）。绝对风险差为-0.03（95%CI，-0.17至0.11；P = 0.66）。对接受化疗的OC患者提供PATP并不能使VTE发生率有统计学意义的降低。不建议对门诊OC患者常规进行PATP。未来有必要进行随机试验来确定可能从PATP中获益的OC高危亚组患者。
