Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
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DOI：
10.1200/jco.2013.49.1118
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发表时间：
2013-06-10
影响因子：
45.3
通讯作者：
Falanga, Anna
中科院分区：
文献类型：
--
作者：
Lyman, Gary H.;Khorana, Alok A.;Falanga, Anna
目的探讨恶性肿瘤患者静脉血栓栓塞症（VTE）的预防和治疗。预防在门诊，住院，围手术期的设置被认为是治疗和使用抗凝治疗作为癌症导向therapy.Methods的系统性综述的文献发表于2007年12月至2012年12月在MEDLINE和科克伦协作图书馆完成。一个更新委员会审查证据，以确定哪些建议需要review. ResultsForty两个出版物符合资格标准，包括16个系统性评价和24个随机对照trials.RecommendationsMost住院癌症患者需要血栓预防在整个住院。血栓预防并不是癌症门诊患者的常规治疗方法。对于选定的高风险患者可考虑使用。接受抗血管生成药物联合化疗和/或地塞米松治疗的多发性骨髓瘤患者应接受低分子量肝素（LMWH）或低剂量阿司匹林预防治疗。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。对于具有高危特征的患者，应考虑延长预防治疗至4周。LMWH推荐用于深静脉血栓形成和肺栓塞治疗的最初5 - 10天以及长期（6个月）二级预防。目前不建议恶性肿瘤和VTE患者使用新型口服抗凝剂。在没有其他适应症的情况下，抗凝剂不应用于癌症治疗。癌症患者应定期评估VTE风险。肿瘤专业人员应向患者提供有关VTE体征和症状的教育。(C)2013年美国临床肿瘤学会
Purpose To provide recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Prophylaxis in the outpatient, inpatient, and perioperative settings was considered, as were treatment and use of anticoagulation as a cancer-directed therapy.Methods A systematic review of the literature published from December 2007 to December 2012 was completed in MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed evidence to determine which recommendations required revision.ResultsForty-two publications met eligibility criteria, including 16 systematic reviews and 24 randomized controlled trials.RecommendationsMost hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE. (C) 2013 by American Society of Clinical Oncology