Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update
Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update
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DOI：
10.1200/jco.19.01461
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发表时间：
2020-02-10
影响因子：
45.3
通讯作者：
Falanga, Anna
中科院分区：
文献类型：
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作者：
Key, Nigel S.;Khorana, Alok A.;Falanga, Anna
目的：为癌症患者静脉血栓栓塞（VTE）的预防和治疗提供最新的建议。方法：检索PubMed和科克伦图书馆2014年8月1日至2018年12月4日发表的随机对照试验（RCT）和RCT的荟萃分析。ASCO召集了一个专家小组，审查证据，并根据需要修订以前的建议。结果系统评价包括35篇关于VTE预防和治疗的出版物和18篇关于VTE风险评估的出版物。两项关于直接口服抗凝剂（DOAC）治疗癌症患者VTE的RCT报告称，在GI和潜在泌尿生殖系统癌症患者中，依度沙班和利伐沙班有效，但与低分子量肝素（LMWH）相比，出血风险更高。两个额外的随机对照试验报告的DOAC血栓预防在流动的癌症患者在增加风险的VTE.Recommendations改变以前的建议：临床医生可以提供血栓预防与阿哌沙班，利伐沙班，或低分子肝素，以选定的高风险门诊癌症患者;利伐沙班和依度沙班已被添加为选项的VTE治疗;脑转移的患者现在在VTE治疗部分解决;关于长期术后LMWH的建议已经扩大。重申的建议：大多数癌症和急性疾病住院患者在住院期间需要血栓预防。血栓预防并不是所有癌症门诊患者的常规建议。接受大型癌症手术的患者应在手术前开始接受预防治疗，并持续至少7至10天。癌症患者应定期评估VTE风险，肿瘤学专业人员应向患者提供有关VTE体征和症状的教育。(C)2019年美国临床肿瘤学会
PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer.METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed.RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE.RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. (C) 2019 by American Society of Clinical Oncology