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抗凝治疗在癌症相关静脉血栓形成中的合理应用。

Proper application of anticoagulation therapy on cancer-associated venous thrombosis.

作者信息

Yhim Ho-Young

机构信息

Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, 54907, Republic of Korea.

出版信息

Blood Res. 2024 Aug 2;59(1):25. doi: 10.1007/s44313-024-00029-3.

Abstract

Cancer-associated venous thromboembolism (VTE) significantly impacts morbidity and mortality. The introduction of direct oral anticoagulants over the past decade has revolutionized VTE treatment in patients with active cancer, offering potential advantages over traditional therapies. However, uncertainties persist regarding the optimal selection and dosage of anticoagulants, particularly in patients with specific risk factors for bleeding, such as certain cancer types (e.g., upper gastrointestinal cancer, genitourinary cancer, primary or metastatic brain tumor, and hematologic malignancies) and specific patient characteristics (e.g., renal dysfunction and thrombocytopenia). Recent data on the thrombotic risk associated with low thrombotic burden VTE, such as subsegmental pulmonary embolism and isolated distal deep vein thrombosis, underscore the need for updated management strategies in daily clinical practice. This review aims to explore these issues and highlight the evolving landscape of cancer-associated VTE management.

摘要

癌症相关的静脉血栓栓塞症(VTE)对发病率和死亡率有显著影响。在过去十年中,直接口服抗凝剂的引入彻底改变了活动性癌症患者的VTE治疗,与传统疗法相比具有潜在优势。然而,关于抗凝剂的最佳选择和剂量仍存在不确定性,尤其是在有特定出血风险因素的患者中,如某些癌症类型(如上部胃肠道癌、泌尿生殖系统癌、原发性或转移性脑肿瘤以及血液系统恶性肿瘤)和特定患者特征(如肾功能不全和血小板减少症)。最近关于低血栓负荷VTE(如亚段肺栓塞和孤立性远端深静脉血栓形成)相关血栓形成风险的数据强调了日常临床实践中更新管理策略的必要性。本综述旨在探讨这些问题,并突出癌症相关VTE管理的不断变化的格局。

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