Graf A H, Graf B, Brandis M G, Kogelnik H D, Staudach A, Traun H
Department of Obstetrics & Gynecology, Salzburg General Hospital, Austria.
Anticancer Res. 1998 May-Jun;18(3B):2047-51.
Venous thromboembolism is reported to be a leading cause of death and morbidity after surgery and during radiotherapy for gynecologic malignancies. This study was performed to evaluate the incidence of thromboembolism as well as the benefit and risk of its prophylaxis with coumarin in this patient selection. Between 1988 and 1992, 132 patients with gynecologic malignancies underwent postoperative or primary radiotherapy (53 patients without prior surgery). Heparin (5000 IU t.i.d., s.c.) was administered perioperatively, and coumarin (International normalized ratio = INR target 2.0-3.5) was given to all patients during radiotherapy. Daily visits for inspection of the legs and for possible symptoms and signs of thromboembolism were performed. In case of diagnostic doubts, impedance plethysmography and phlebography for diagnosis of venous thrombosis, and lung scanning for diagnosis of pulmonary embolism were performed. Among the 132 patients, 9 (6.8%) developed deep venous thrombosis of the renal vein and of the inferior caval vein occurred in one additional patient. Pulmonary embolism was detected in 5 patients (3.8%). All thromboembolic events were without lethal outcome. Bleeding episodes were observed in 7 patients (5.3%); in two of them a major bleeding led to cessation of coumarin administration. The prophylaxis of thromboembolism in gynecologic oncology with coumarin seems to be effective, safe and inexpensive.
据报道，静脉血栓栓塞是妇科恶性肿瘤手术后及放疗期间死亡和发病的主要原因。本研究旨在评估该患者群体中血栓栓塞的发生率以及使用香豆素进行预防的益处和风险。1988年至1992年间，132例妇科恶性肿瘤患者接受了术后放疗或根治性放疗（53例患者未接受过手术）。围手术期给予肝素（5000 IU，每日3次，皮下注射），放疗期间所有患者均给予香豆素（国际标准化比值= INR目标值2.0 - 3.5）。每天检查腿部，观察是否有血栓栓塞的症状和体征。如有诊断疑问，则进行阻抗体积描记法和静脉造影以诊断静脉血栓形成，进行肺部扫描以诊断肺栓塞。132例患者中，9例（6.8%）发生肾静脉深静脉血栓形成，另有1例发生下腔静脉血栓形成。5例患者（3.8%）检测到肺栓塞。所有血栓栓塞事件均无致命后果。7例患者（5.3%）出现出血事件；其中2例严重出血导致香豆素停药。在妇科肿瘤学中，使用香豆素预防血栓栓塞似乎有效、安全且成本低廉。
