Levine M
Ontario Cancer Treatment & Research Foundation, Hamilton Regional Cancer Centre, Department of Medicine, McMaster University, Ont., Canada.
Haemostasis. 1997;27 Suppl 1:38-43. doi: 10.1159/000217481.
Cancer patients are in a hypercoagulable state. The pathogenesis of thrombosis in malignancy is multifactorial with mechanisms including release of procoagulants by tumour cells, comorbid predisposing factors (bed rest, infection, surgery, etc.) and anti-cancer drugs. Cancer patients with established venous thromboembolism are more likely to develop recurrent venous thromboembolism during treatment with oral anticoagulants. This paper reviews the use of heparin for the treatment of thrombotic disorders in cancer patients. Treatment of acute venous thrombosis comprises initial heparin administration, which for a cancer patient should last for at least 5 days, followed by administration of oral anticoagulants. Low-molecular-weight heparins (LMWHs) have been shown to be as safe and effective as standard heparin for the treatment of acute deep vein thrombosis. Recent meta-analyses have revealed lower mortality rates with LMWH than with standard heparin, indicating that LMWH may exert an inhibitory effect on tumour growth that is not observed with standard heparin.
癌症患者处于高凝状态。恶性肿瘤中血栓形成的发病机制是多因素的，其机制包括肿瘤细胞释放促凝剂、合并的易感因素（卧床休息、感染、手术等）以及抗癌药物。已发生静脉血栓栓塞的癌症患者在接受口服抗凝剂治疗期间更有可能发生复发性静脉血栓栓塞。本文综述了肝素在癌症患者血栓性疾病治疗中的应用。急性静脉血栓形成的治疗包括初始给予肝素，对于癌症患者，肝素治疗应至少持续5天，随后给予口服抗凝剂。低分子量肝素（LMWHs）已被证明在治疗急性深静脉血栓形成方面与标准肝素一样安全有效。最近的荟萃分析显示，与标准肝素相比，低分子量肝素的死亡率更低，这表明低分子量肝素可能对肿瘤生长具有抑制作用，而标准肝素则未观察到这种作用。
