Parmentier Stefani, Koschmieder Steffen, Henze Larissa, Griesshammer Martin, Matzdorff Axel, Bakchoul Tamam, Langer Florian, Alesci Rosa Sonja, Duerschmied Daniel, Thomalla Goetz, Riess Hanno
Tumorzentrum, St. Claraspital Tumorzentrum, St. Claraspital, Basel, Basel-Stadt, Switzerland.
Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
Hamostaseologie. 2024 Jul 15. doi: 10.1055/a-2337-4025.
Active cancer by itself but also chemotherapy is associated with an increased risk of cardiovascular disease (CVD) and especially coronary artery disease (CAD) and atrial fibrillation (AF). The frequency of CVD, CAD, and AF varies depending on comorbidities (particularly in older patients), cancer type, and stage, as well as the anticancer therapeutic being taken. Many reports exist for anticancer drugs being associated with CVD, CAD, and AF, but robust data are often lacking. Because of this, each patient needs an individual structured approach concerning thromboembolic and bleeding risk, drug-drug interactions, as well as patient preferences to evaluate the need for anticoagulation therapy and targeting optimal symptom control. Interruption of specific cancer therapy should be avoided to reduce the potential risk of cancer progression. Nevertheless, additional factors like thrombocytopenia and anticoagulation in the elderly and frail patient with cancer cause additional challenges which need to be addressed in daily clinical management. Therefore, the aim of these recommendations is to summarize the available scientific data on antithrombotic therapy (both antiplatelet and anticoagulant therapy) in cancer patients with CVD and in cases of missing data providing guidance for optimal careful decision-making in daily routine.
活动性癌症本身以及化疗都与心血管疾病（CVD）风险增加相关，尤其是冠状动脉疾病（CAD）和心房颤动（AF）。CVD、CAD和AF的发生率因合并症（尤其是老年患者）、癌症类型和分期以及所采用的抗癌治疗方法而异。关于抗癌药物与CVD、CAD和AF相关的报道很多，但往往缺乏确凿的数据。因此，对于每一位患者，都需要采取个性化的结构化方法来评估血栓栓塞和出血风险、药物相互作用以及患者偏好，以确定是否需要抗凝治疗并实现最佳症状控制。应避免中断特定的癌症治疗，以降低癌症进展的潜在风险。然而，诸如血小板减少症以及老年和体弱癌症患者的抗凝治疗等其他因素会带来额外挑战，需要在日常临床管理中加以应对。因此，这些建议的目的是总结癌症合并CVD患者抗血栓治疗（包括抗血小板和抗凝治疗）的现有科学数据，并在数据缺失的情况下为日常临床实践中的最佳谨慎决策提供指导。
