Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.
Ankara University Cancer Research Institute, Ankara, Turkey.
Cancer. 2023 Oct 15;129(20):3216-3229. doi: 10.1002/cncr.34937. Epub 2023 Jul 4.
Venous thromboembolism (VTE) is often associated with malignant diseases and notably contributes to morbidity and mortality in patients with cancer. Cancer-associated thrombosis (CAT) brings additional costs to health expenditures and has a negative impact on oncological outcomes. Either the recurrence rate of VTE or bleeding complications are also higher in patients with cancer. Prophylactic anticoagulation has been recommended in peri-surgical periods, inpatient settings, and high-risk ambulatory patients. Although various risk stratification scores are used, none are ideal for identifying patients who can benefit from anticoagulant prophylaxis. New risk scoring systems or biomarkers are needed to identify patients who are more likely to benefit from prophylaxis with low bleeding risk. The questions about the patients who will be given prophylaxis and those who develop thromboembolism, with which drug, and how long they will be treated are still not fully answered. Anticoagulation is the cornerstone of the treatment, but management of CAT remains complex. Low molecular weight heparins and direct oral anticoagulants are effective and safe options for the treatment of CAT. Recognizing adverse effects, drug-drug interactions, and accompanying conditions that cause dose adjustment is crucial. Prevention and treatment of VTE in patients with cancer require a multidisciplinary and patient-based approach. PLAIN LANGUAGE SUMMARY: Cancer-associated thrombosis is a significant cause of mortality and morbidity in patients with cancer. Chemotherapy, surgery, and/or use of central venous access remarkably increase the risk of thrombosis. Prophylactic anticoagulation should be considered not only in inpatient follow-up and during peri-surgical period but also ambulatory patients with a high risk of thrombosis. Many parameters, such as drug-drug interactions, primary side of cancer, and comorbidities of patients should be considered when selecting anticoagulant drugs. More accurate risk stratification scores or biomarkers are still an unmet need.
静脉血栓栓塞症（VTE）常与恶性肿瘤相关，并显著增加癌症患者的发病率和死亡率。癌症相关性血栓形成（CAT）增加了医疗支出，并对肿瘤学结局产生负面影响。癌症患者的 VTE 复发率或出血并发症发生率也更高。围手术期、住院期间和高风险门诊患者均推荐预防性抗凝治疗。尽管使用了各种风险分层评分，但没有一种评分能够理想地识别出可从抗凝预防中获益的患者。需要新的风险评分系统或生物标志物来识别更有可能从低出血风险的预防中获益的患者。关于哪些患者需要给予预防措施、哪些患者发生血栓栓塞、使用哪种药物以及治疗多长时间的问题仍未得到充分回答。抗凝是治疗的基石，但 CAT 的管理仍然很复杂。低分子肝素和直接口服抗凝剂是治疗 CAT 的有效和安全选择。识别不良反应、药物相互作用以及导致剂量调整的伴随疾病至关重要。癌症患者的 VTE 的预防和治疗需要多学科和基于患者的方法。
