Xu Sheng, Bie Zhi-Xin, Li Yuan-Ming, Li Bin, Peng Jin-Zhao, Kong Fan-Lei, Li Xiao-Guang
Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Quant Imaging Med Surg. 2022 Jun;12(6):3251-3263. doi: 10.21037/qims-21-1043.
For non-small cell lung cancer (NSCLC) patients on antithrombotic therapy who are treated with microwave ablation (MWA), the transient interruption of antithrombotic agents may increase the risk of thromboembolism, and continuation of antithrombotic agents may increase the risk of intraprocedural hemorrhage. This retrospective cohort study aimed to explore the safety of MWA in patients with NSCLC on antithrombotic therapy.
A total of 572 patients with NSCLC (antithrombotic therapy group: n=84, Group A; control group: n=488, Group B) who received MWA were included. Antithrombotic agent use was suspended before MWA and resumed as soon as possible after MWA. Hemorrhagic (hemothorax and hemoptysis) and thromboembolic complications (pulmonary embolism, cerebral infarction, and angina) were compared. Logistic regression analyses were used to investigate the predictors of hemorrhagic complications after MWA.
Hemorrhagic complications occurred in 8 participants (9.5%) from Group A and 33 participants (6.8%) from Group B, and no statistically significant difference was found (P=0.365). There were 3 participants (0.5%) who developed thromboembolic complications, including 1 case (1.2%, 1/84) of pulmonary embolism in Group A, and 2 cases (0.4%, 2/488) of cerebral infarction or angina in Group B; no significant difference was found (P=0.923). In the subgroup analyses of Group A, no statistically significant difference of hemorrhagic (P>0.999) or thromboembolic complications (P>0.999) was found between patients who received and did not receive bridging anticoagulation with heparin. Logistic regression analyses revealed that direct contact of a tumor with vessels ≥2 mm was a predictor of hemorrhagic complications [hazard ratio (HR) =2.318; 95% confidence interval (CI): 1.215-4.420; P=0.011], while antithrombotic therapy was irrelevant.
With the appropriate cessation and resumption of antithrombotic agents, patients with NSCLC on antithrombotic therapy have comparable incidence rates of hemorrhagic and thromboembolic complications after MWA to those of patients who are not on antithrombotic therapy. Therefore, with appropriate cessation, MWA appears to generally be safe for NSCLC patients on antithrombotic therapy.
对于接受抗血栓治疗的非小细胞肺癌（NSCLC）患者，在进行微波消融（MWA）治疗时，暂时中断抗血栓药物可能会增加血栓栓塞风险，而继续使用抗血栓药物可能会增加术中出血风险。这项回顾性队列研究旨在探讨MWA在接受抗血栓治疗的NSCLC患者中的安全性。
共纳入572例接受MWA治疗的NSCLC患者（抗血栓治疗组：n = 84，A组；对照组：n = 488，B组）。在MWA治疗前暂停使用抗血栓药物，并在MWA治疗后尽快恢复使用。比较出血性（血胸和咯血）和血栓栓塞性并发症（肺栓塞、脑梗死和心绞痛）。采用逻辑回归分析来研究MWA治疗后出血性并发症的预测因素。
A组有8名参与者（9.5%）发生出血性并发症，B组有33名参与者（6.8%）发生出血性并发症，差异无统计学意义（P = 0.365）。有3名参与者（0.5%）发生血栓栓塞性并发症，包括A组1例（1.2%，1/84）肺栓塞，B组2例（0.4%，2/488）脑梗死或心绞痛；差异无统计学意义（P = 0.923）。在A组的亚组分析中，接受和未接受肝素桥接抗凝的患者之间，出血性（P>0.999）或血栓栓塞性并发症（P>0.999）差异均无统计学意义。逻辑回归分析显示，肿瘤与≥2mm血管直接接触是出血性并发症的预测因素[风险比（HR）=2.318；95%置信区间（CI）：1.215 - 4.420；P = 0.011]，而抗血栓治疗与之无关。
通过适当停用和恢复抗血栓药物，接受抗血栓治疗的NSCLC患者在MWA治疗后出血性和血栓栓塞性并发症的发生率与未接受抗血栓治疗的患者相当。因此，通过适当停用，MWA对于接受抗血栓治疗的NSCLC患者似乎总体上是安全的。
