Adrián Silvia García, Pérez Claudia Iglesias, Carmona-Bayonas Alberto, Morán Laura Ortega, Pérez Jaime Rubio, Del Prado Purificación Martínez, De Castro Eva Martínez, Neria Fernando, Pérez Isaura Fernández, De Herreros Marta García, Campos Marta Carmona, Escobar Ignacio García, Balanyà Rut Porta, González David Marrupe, Fonseca Paula Jiménez, García María Esperanza Guirao, Cánovas Manuel Sánchez, Langa José Muñoz, Segura Pedro Pérez, Vidal Ma José Méndez, Martín Andrés J Muñoz, Medical Oncology Spanish Society Of
Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM).
Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Universidad de Oviedo, Oviedo.
Haematologica. 2025 Jul 1;110(7):1513-1522. doi: 10.3324/haematol.2024.286152. Epub 2024 Dec 12.
Patients with cancer have a higher risk of re-thrombosis and bleeding secondary to anticoagulant treatment than have individuals without cancer. Given the lack of specific clinical trials, the decision regarding the optimal duration of treatment must consider multiple factors, including sex. The current study used data from the international, prospective TESEO Registry that includes consecutive patients diagnosed with cancer-associated thrombosis. Between July 2018 and December 2022, 2,823 patients were included in the TESEO Registry, 1,351 (48%) of whom were female. The most common venous thromboembolic event (VTE) in both sexes was pulmonary embolism, with an incidence of 58.0% among men and 54.3% in women (P=0.045). After a median follow-up of 6.9 months (interquartile range, 1.9-14.4), the re-thrombosis rate at the end of follow-up was 10.0% in males and 15.0% in females (P=0.14). The location of the primary tumor in the gastrointestinal tract was associated with a greater risk of re-thrombosis, whereas sex had no significant impact. Men had twice as many major bleeds. Additional risk factors for major bleeding included situations of risk due to tumor site or thrombocytopenia, as well as the presence of active tumor bleeding at the time of VTE diagnosis. Overall survival was longer among women. Given the higher incidence of major bleeding among men, sex should be deemed a relevant factor when deciding the duration of anticoagulant treatment in cancer patients.
与无癌症个体相比，癌症患者因抗凝治疗继发再发血栓形成和出血的风险更高。鉴于缺乏具体的临床试验，关于最佳治疗持续时间的决策必须考虑多个因素，包括性别。本研究使用了国际前瞻性TESEO注册中心的数据，该中心纳入了连续诊断为癌症相关血栓形成的患者。2018年7月至2022年12月期间，TESEO注册中心纳入了2823例患者，其中1351例（48%）为女性。两性中最常见的静脉血栓栓塞事件（VTE）是肺栓塞，男性发生率为58.0%，女性为54.3%（P=0.045）。中位随访6.9个月（四分位间距，1.9 - 14.4）后，随访结束时男性再发血栓形成率为10.0%，女性为15.0%（P=0.14）。原发肿瘤位于胃肠道与再发血栓形成风险增加相关，而性别无显著影响。男性严重出血的发生率是女性的两倍。严重出血的其他危险因素包括肿瘤部位或血小板减少导致的风险情况，以及VTE诊断时存在活动性肿瘤出血。女性的总生存期更长。鉴于男性严重出血的发生率较高，在决定癌症患者抗凝治疗持续时间时，应将性别视为一个相关因素。
