Zwicker Jeffrey I
Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY; and Weill Cornell Medical College, New York, NY.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):253-258. doi: 10.1182/hematology.2024000552.
Managing recurrent and refractory venous thromboembolism (VTE) in patients with cancer presents unique challenges. This review outlines the complexities and therapeutic strategies for recurrent VTE in cancer patients, which includes distinguishing thrombus acuity, differentiating between tumor and bland thrombi, and evaluating potential contributing factors including anticoagulant adherence, extrinsic tumor compression, drug interactions, and anticoagulant-specific considerations such as heparin-induced thrombocytopenia or antithrombin deficiency. Different anticoagulation strategies are discussed, including the administration of escalated-dose low molecular weight heparin (LMWH) as well as the indications and rationale for switching between direct oral anticoagulants or LMWH.
管理癌症患者复发性和难治性静脉血栓栓塞症（VTE）面临着独特的挑战。本综述概述了癌症患者复发性VTE的复杂性和治疗策略，包括区分血栓的急性程度、鉴别肿瘤性血栓和单纯性血栓，以及评估潜在的促成因素，如抗凝药物依从性、外在肿瘤压迫、药物相互作用，以及抗凝药物特异性考量因素，如肝素诱导的血小板减少症或抗凝血酶缺乏。文中讨论了不同的抗凝策略，包括给予递增剂量的低分子量肝素（LMWH），以及在直接口服抗凝剂或LMWH之间切换的适应症和基本原理。
