Englisch Cornelia, Vladic Nikola, Ay Cihan
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna; Vienna, Austria.
Department of Obstetrics, Gynecology and Perinatal Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Hamostaseologie. 2025 Apr;45(2):188-203. doi: 10.1055/a-2347-6507. Epub 2024 Sep 3.
The hemostatic system and cancer display a tight interconnection, and hemostatic imbalance frequently occurs in patients with cancer. While extensive knowledge about thrombotic risk has been generated, less is known about bleeding risk and associated risk factors. However, bleeding risk is of high significance as patients with cancer frequently receive therapeutic anticoagulation for various indications and/or are candidates for primary thromboprophylaxis. The risk of bleeding in patients with cancer is variable and difficult to assess in clinical practice. Certain clinical settings such as hospitalization, specific underlying risk factors (e.g., tumor type), and medications (e.g., anticoagulation) can contribute to the individual bleeding risk of a patient with cancer. In addition, some dynamic factors such as platelet count or kidney function have an impact. Particularly, data on baseline risk of bleeding are lacking to allow for risk assessment in cancer patients without anticoagulation. In contrast, risk assessment models for the prediction of bleeding events in cancer patients receiving anticoagulation have been developed; however, these have yet to be validated. The recognition of the importance of bleeding risk in cancer patients is growing, leading to an increasing number of studies investigating and reporting bleeding complications. As study designs and reporting of bleeding events vary, it is challenging to offer a clear synthesis of evidence. In this narrative review, we provide an overview of currently available data about incidence, risk factors, and clinical impact of bleeding events in patients with cancer, and critically review risk assessment models for bleeding in cancer patients during anticoagulant therapy.
止血系统与癌症之间存在紧密联系，癌症患者常出现止血失衡。虽然人们已经对血栓形成风险有了广泛了解，但对于出血风险及其相关危险因素的了解却较少。然而，出血风险具有重要意义，因为癌症患者常因各种适应症接受治疗性抗凝治疗和/或作为原发性血栓预防的对象。癌症患者的出血风险具有多样性，在临床实践中难以评估。某些临床情况，如住院、特定的潜在危险因素（如肿瘤类型）和药物（如抗凝药物），都可能导致癌症患者个体的出血风险。此外，一些动态因素，如血小板计数或肾功能，也会产生影响。特别是，缺乏关于无抗凝治疗的癌症患者出血基线风险的数据，无法进行风险评估。相比之下，已经开发出用于预测接受抗凝治疗的癌症患者出血事件的风险评估模型；然而，这些模型尚未得到验证。人们对癌症患者出血风险重要性的认识不断提高，导致越来越多的研究对出血并发症进行调查和报告。由于出血事件的研究设计和报告各不相同，因此要清晰地综合证据具有挑战性。在这篇叙述性综述中，我们概述了目前有关癌症患者出血事件的发生率、危险因素和临床影响的可用数据，并批判性地审视了癌症患者在抗凝治疗期间出血的风险评估模型。
