Division of Hematology, Washington University School of Medicine St. Louis, St. Louis, MO, USA.
Division of Hematology/Oncology, St. Louis Veterans Administration Medical Center, St. Louis, MO, USA.
Br J Haematol. 2022 Sep;198(5):812-825. doi: 10.1111/bjh.18276. Epub 2022 May 25.
Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. Treatment of cancer-associated VTE comes with a heightened risk of anticoagulant-related bleeding that differs by choice of anticoagulant as well as by patient- and disease-specific risk factors. Available data from randomized controlled trials and observational studies in cancer-associated VTE suggest that direct oral anticoagulants are effective, continuing anticoagulation beyond six months is indicated in those with active cancer and that patients who develop 'breakthrough' thrombotic events can be effectively treated. We review the evidence that addresses these key clinical questions and offer pragmatic approaches in individualizing care. While significant investigative efforts over the past decade have made impactful advances, future research is needed to better define the factors that contribute to anticoagulant-related bleeding and VTE recurrence, in order to aid clinical decision-making that improves the care of patients with cancer-associated VTE.
癌症相关静脉血栓栓塞症（VTE）是癌症患者发病率和死亡率的主要原因。癌症相关 VTE 的治疗伴随着抗凝相关出血的风险增加，这种风险因抗凝药物的选择以及患者和疾病的特定风险因素而异。来自癌症相关 VTE 的随机对照试验和观察性研究的现有数据表明，直接口服抗凝剂是有效的，在有活动性癌症的患者中，建议继续抗凝超过六个月，并且可以有效地治疗发生“突破性”血栓事件的患者。我们回顾了这些关键临床问题的证据，并提供了个性化治疗的实用方法。虽然过去十年的大量研究工作取得了重大进展，但仍需要进一步研究以更好地确定导致抗凝相关出血和 VTE 复发的因素，以帮助临床决策，从而改善癌症相关 VTE 患者的治疗。
