荷兰癌症相关血栓形成的治疗与预防：一项全国性调查。
Treatment and prevention of cancer-associated thrombosis in the Netherlands: A national survey.
作者信息
Kaptein Fleur H J, Guman Noori A M, van Es Nick, Kamphuisen Pieter W, Klok Frederikus A, Mairuhu Albert T A, Huisman Menno V
机构信息
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Department of Vascular Medicine, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands.
出版信息
Res Pract Thromb Haemost. 2023 Jan 24;7(1):100057. doi: 10.1016/j.rpth.2023.100057. eCollection 2023 Jan.
BACKGROUND
In the recent years, numerous studies on the optimal treatment and prevention of cancer-associated venous thromboembolism (VTE) have been published, leading to updated (inter)national guidelines. These include direct oral anticoagulants (DOACs) as the first-line treatment agent in general and the recommendation of primary thromboprophylaxis in selected ambulatory patients.
OBJECTIVES
The objective of this study was to evaluate the clinical practice regarding treatment and prevention of VTE in patients with cancer in the Netherlands and practice variation among different specialties.
METHODS
An online survey was conducted between December 2021, and June 2022, among Dutch physicians (oncologists, hematologists, vascular medicine specialists, acute internal medicine specialists, and pulmonologists) treating patients with cancer, in which we explored the treatment of choice for cancer-associated VTE, the use of VTE risk stratification tools, and primary thromboprophylaxis.
RESULTS
A total of 222 physicians participated, of whom the majority (81%) used DOACs as a first-line agent for treating cancer-associated VTE. The treatment varied between the following specialties: hematologists and acute internal medicine specialists more often prescribed low-molecular-weight heparin than physicians of the other specialties (OR, 0.32; 95% CI, 0.13-0.80). The minimum duration of anticoagulant treatment was usually 3 to 6 months (87%), and treatment was extended when the malignancy was still active (98%). Regarding the prevention of cancer-associated VTE, no risk stratification tool was used. Three quarters of respondents never prescribed thromboprophylaxis to ambulatory patients, mostly because the thrombosis risk was not perceived high enough to justify prophylaxis.
CONCLUSION
Dutch physicians largely adhere to the updated guidelines regarding the treatment of cancer-associated VTE but less to the recommendations for its prevention.
背景
近年来，发表了许多关于癌症相关静脉血栓栓塞症（VTE）的最佳治疗和预防的研究，从而产生了更新的（国际）指南。这些指南一般将直接口服抗凝剂（DOACs）作为一线治疗药物，并建议对选定的门诊患者进行一级血栓预防。
目的
本研究的目的是评估荷兰癌症患者VTE治疗和预防的临床实践以及不同专科之间的实践差异。
方法
在2021年12月至2022年6月期间，对荷兰治疗癌症患者的医生（肿瘤学家、血液学家、血管医学专家、急性内科专家和肺科医生）进行了一项在线调查，我们探讨了癌症相关VTE的首选治疗方法、VTE风险分层工具的使用以及一级血栓预防。
结果
共有222名医生参与，其中大多数（81%）使用DOACs作为治疗癌症相关VTE的一线药物。不同专科之间的治疗方法有所不同：血液学家和急性内科专家比其他专科的医生更常开具低分子肝素（OR，0.32；95%CI，0.13-0.80）。抗凝治疗的最短持续时间通常为3至6个月（87%），当恶性肿瘤仍处于活动期时，治疗会延长（98%）。关于癌症相关VTE的预防，未使用风险分层工具。四分之三的受访者从未给门诊患者开具过血栓预防药物，主要是因为他们认为血栓形成风险不够高，不值得进行预防。
结论
荷兰医生在很大程度上遵循了关于癌症相关VTE治疗的更新指南，但在预防方面较少遵循相关建议。
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