Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis
Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis
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DOI：
10.1182/blood-2002-01-0108
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发表时间：
2002-11-15
期刊：
影响因子：
20.3
通讯作者：
Girolami, A
中科院分区：
文献类型：
--
作者：
Prandoni, P;Lensing, AWA;Girolami, A
一小部分深静脉血栓形成患者在抗凝治疗期间会出现复发性静脉血栓栓塞并发症或出血。如果这些患者伴有癌症，这些并发症可能会更频繁地发生。这项前瞻性随访研究旨在确定在血栓形成患者中，癌症患者在抗凝治疗期间复发静脉血栓栓塞或出血的风险是否高于非癌症患者。在纳入的842例患者中，181例在入组时已知患有癌症。癌症患者12个月累积血栓栓塞复发率为20.7%（95% CI，15.6%-25.8%）vs 6.8%（95% CI，3.9%-9.7%）在非癌症患者中，风险比为3.2（95% CI，1.9-5.4）12个月累积大出血发生率为12.4%（95%CI，6.5%-18.2%），非癌症患者为4.9%（95%CI，2.5%-7.4%），风险比为2.2（95%CI，1.2-4.1）。复发和出血均与癌症严重程度相关，主要发生在抗凝治疗的第一个月，但不能用抗凝不足或过度来解释。静脉血栓形成的癌症患者比没有恶性肿瘤的患者更容易在抗凝治疗期间发生复发性血栓栓塞并发症和大出血。这些风险与癌症的程度有关。使用当前抗凝治疗范例的改善可能性似乎有限，应开发新的治疗策略。
A small proportion of patients with deep vein thrombosis develop recurrent venous thromboembolic complications or bleeding during anticoagulant treatment. These complications may occur more frequently if these patients have concomitant cancer. This prospective follow-up study sought to determine whether in thrombosis patients those with cancer have a higher risk for recurrent venous thromboembolism or bleeding during anticoagulant treatment than those without cancer. Of the 842 included patients, 181 had known cancer at entry. The 12-month cumulative incidence of recurrent thromboembolism in cancer patients was 20.7% (95% CI, 15.6%-25.8%) versus 6.8% (95% CI, 3.9%-9.7%) In patients without cancer, for a hazard ratio of 3.2 (95% CI, 1.9-5.4) The 12-month cumulative incidence of major bleeding was 12.4% (95% CI, 6.5%18.2%) in patients with cancer and 4.9% (95% CI, 2.5%-7.4%) in patients without cancer, for a hazard ratio of 2.2 (95% CI, 1.2-4.1). Recurrence and bleeding were both related to cancer severity and occurred predominantly during the first month of anticoagulant therapy but could not be explained by sub- or overanticoagulation. Cancer patients with venous thrombosis are more likely to develop recurrent thromboembolic complications and major bleeding during anticoagulant treatment than those without malignancy. These risks correlate with the extent of cancer. Possibilities for Improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed.