Cardiopulmonary Department - Heart Institute, University of Sao Paulo Medical School, 44, Av. Dr. Eneas de Carvalho Aguiar, São Paulo, SP, 05403-000, Brazil.
Sirio Libanes Hospital, 115, Adma Jafet St, Sao Paulo, SP, Brazil.
Curr Oncol Rep. 2023 May;25(5):425-432. doi: 10.1007/s11912-023-01384-7. Epub 2023 Mar 16.
This review aims to assess the treatment options for cancer-associated venous thromboembolism (VTE) based on the most robust level of evidence recommendations and suggestions based on expert opinion.
Several classes of anticoagulants have been studied in the treatment of cancer-associated thrombosis (CAT). Since the CLOT trial, guidelines recommend the use of low-molecular-weight heparin (LMWH) for the treatment of this condition. However, since 2018, some direct oral anticoagulants became an alternative first-line treatment for CAT. Three Xa antagonists (rivaroxaban, apixaban, and edoxaban) proved to be at least as effective as the LMWH strategy for the short-term prevention of VTE recurrence. The right choice of treatment in the context of anticoagulation strategy, thrombo-hemorrhagic risk management, and a patient's comorbidities represents a challenge. The correct management of CAT and a more individualized approach are needed to identify risk factors and offer the best treatment for each patient.
本综述旨在根据最具说服力的循证建议和专家意见评估癌症相关静脉血栓栓塞(VTE)的治疗选择。
已有几类抗凝剂被用于治疗癌症相关性血栓形成(CAT)。自 CLOT 试验以来,指南建议使用低分子量肝素(LMWH)治疗该病症。然而,自 2018 年以来,一些直接口服抗凝剂成为 CAT 的一线替代治疗药物。三种 Xa 拮抗剂(利伐沙班、阿哌沙班和依度沙班)在预防 VTE 复发的短期疗效方面至少与 LMWH 策略一样有效。在抗凝策略、血栓出血风险管理和患者合并症的背景下,选择正确的治疗方法是一项挑战。需要对 CAT 进行正确的管理并采用更个体化的方法来识别风险因素并为每位患者提供最佳治疗。