Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMJ. 2023 Jun 1;381:e072715. doi: 10.1136/bmj-2022-072715.
Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing death in this high risk population. Various risk models predictive of venous thromboembolism in patients with cancer have been developed, and knowledge of these rubrics is essential for the treating oncologist. Subgroups of particular interest are inpatients receiving chemotherapy, postoperative patients after surgical debulking, and patients undergoing radiotherapy. Numerous newer drugs have become available for the prevention of venous thromboembolism in patients with cancer who are at high risk of developing the disease. These include the class of drugs called direct oral anticoagulants, (DOACs) which do not require the same monitoring that other modalities have previously required and are taken by mouth, preventing the discomfort associated with subcutaneous strategies. The appropriate risk stratification and intervention to prevent venous thromboembolism are vital to the treatment of patients with cancer.
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。静脉血栓栓塞症包括深静脉血栓形成和肺栓塞,影响相当一部分恶性肿瘤患者,并可能导致潜在的危及生命的并发症。准确评估风险以及诊断和治疗这一过程对于预防高危人群死亡至关重要。已经开发出了多种预测癌症患者静脉血栓栓塞症的风险模型,了解这些分类对于治疗肿瘤学家至关重要。特别关注的亚组是接受化疗的住院患者、手术后进行手术去瘤的患者以及接受放疗的患者。许多新型药物可用于预防高危癌症患者发生静脉血栓栓塞症,这些药物包括称为直接口服抗凝剂(DOACs)的药物类别,它们不需要像以前的方法那样进行相同的监测,并且可以口服,避免与皮下策略相关的不适。适当的风险分层和干预措施以预防静脉血栓栓塞症对于癌症患者的治疗至关重要。