Équipe mobile territoriale soins palliatifs, hôpital Joseph-Imbert d'Arles, Arles, France; F-CRIN INNOVTE network, Saint-Étienne, France.
Service de médecine vasculaire, EA Chimère 7516, CHU d'Amiens-Picardie, Amiens, France; F-CRIN INNOVTE network, Saint-Étienne, France.
Arch Cardiovasc Dis. 2024 Jan;117(1):94-100. doi: 10.1016/j.acvd.2023.11.008. Epub 2023 Nov 23.
Many patients with cancer require palliative care at some stage and the vast majority of people followed in palliative care are cancer patients. Patients with cancer are at high risk of venous thromboembolism (VTE), and this is particularly true during the advanced palliative phase when mobility is limited or absent. Patients with cancer in palliative cancer are at higher bleeding risk compared to non-cancer patients. Decisions to treat VTE or withhold anticoagulation for these patients have proven to be difficult and depend largely on an individual clinician's judgment. For this reason, we have developed a consensus proposal for appropriate management of cancer-associated thromboembolism (CAT) in patients in palliative care, which is presented in this article. The proposal was informed by the recent scientific literature retrieved through a systematic literature review. In cancer patients in advanced palliative care, the benefit-risk ratio of anticoagulation seems unfavourable with a higher haemorrhagic risk than the benefit associated with prevention of CAT recurrence and, above all, in the absence of any benefit on quality of life. For this reason, we recommend that patients should be prescribed anticoagulants on a case-by-case basis. The choice of whether to treat, and with which type of treatment, should take into account anticipated life expectancy and patient preferences, as well as clinical factors such as the estimated bleeding risk, the type of VTE experienced and the time since the VTE event.
许多癌症患者在某个阶段需要姑息治疗，而且绝大多数接受姑息治疗的人都是癌症患者。癌症患者有发生静脉血栓栓塞（VTE）的高风险，尤其是在晚期姑息阶段，活动能力有限或不存在时。与非癌症患者相比，姑息治疗癌症患者的出血风险更高。为这些患者治疗 VTE 或不抗凝的决定被证明是困难的，并且在很大程度上取决于个体临床医生的判断。出于这个原因，我们为姑息治疗中的癌症相关血栓栓塞（CAT）患者制定了适当的管理共识建议，本文对此进行了介绍。该建议是通过系统文献回顾检索到的最新科学文献提供信息的。在晚期姑息治疗的癌症患者中，抗凝的获益-风险比似乎不利，出血风险高于预防 CAT 复发的获益，尤其是在对生活质量没有任何获益的情况下。因此，我们建议应根据具体情况为患者开抗凝剂。是否进行治疗以及选择哪种治疗类型应考虑预期的预期寿命和患者偏好，以及临床因素，如估计的出血风险、经历的 VTE 类型以及 VTE 事件发生后的时间。
