Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review.
Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review.
复制标题
癌症患者的静脉和动脉血栓栓塞症：JACC：心脏肿瘤学最新进展。
DOI：
10.1016/j.jaccao.2021.03.001
复制
发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Khorana AA
中科院分区：
文献类型：
--
作者：
Gervaso L;Dave H;Khorana AA
静脉血栓栓塞（VTE），包括深静脉血栓形成和肺栓塞，是癌症患者发病率和死亡率的主要原因。动脉血栓栓塞，包括心肌梗塞和中风，也很普遍。风险在亚组中不同，在特定癌症中观察到更高的比率，包括胰腺癌，胃癌和多发性骨髓瘤。血栓预防被推荐用于大多数因内科疾病住院和大型癌症手术后的活动性癌症患者。门诊血栓预防并不被常规推荐，但新出现的数据表明，可以使用经验证的风险工具识别从药物血栓预防中获益的高危人群。直接口服抗凝剂正在成为治疗癌症相关性VTE的首选新选择，尽管低分子量肝素仍然是高出血风险患者的标准药物。前6个月后的VTE管理和具有挑战性的临床情况（包括颅内转移和血小板减少）需要谨慎管理，以平衡抗凝治疗的获益和风险，并且证据仍存在重大知识差距。癌症患者发生VTE和ATE的风险增加，并导致包括死亡在内的严重后果。结合临床和生化参数的RAM可以识别高风险患者。对于确定为VTE高风险的患者，应考虑进行血栓预防。DOAC是急性VTE治疗的新兴选择，尽管LMWH仍然是可接受的标准。关于癌症患者ATE管理的数据有限。目前建议采用肿瘤科医生和心脏科医生的多学科方法。
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Arterial thromboembolism, including myocardial infarction and stroke, is also prevalent. Risk differs in subgroups, with higher rates observed in specific cancers including pancreas, stomach, and multiple myeloma. Thromboprophylaxis is recommended for most patients with active cancer hospitalized for medical illnesses and after major cancer surgery. Outpatient thromboprophylaxis is not routinely recommended, but emerging data suggest that a high-risk population that benefits from pharmacological thromboprophylaxis can be identified using a validated risk tool. Direct oral anticoagulants are emerging as the preferred new option for the treatment of cancer-associated VTE, although low-molecular-weight heparin remains a standard for patients at high bleeding risk. Management of VTE beyond the first 6 months and challenging clinical situations including intracranial metastases and thrombocytopenia require careful management in balancing the benefits and risks of anticoagulation and remain major knowledge gaps in evidence. Patients with cancer are at increased risk of VTE and ATE, with significant consequences including mortality. RAMs combining clinical and biochemical parameters can identify high-risk patients. Thromboprophylaxis should be considered for patients identified as high-risk for VTE. DOACs are an emerging option for acute VTE treatment, although LMWH remains an acceptable standard. There are limited data that address the management of ATE in patients with cancer. A multidisciplinary approach with the oncologist and cardiologist is currently recommended.
登录
查看更多内容
影响因子：
10.4
作者：
Di Nisio, M.;Carrier, M.;Khorana, A. A.
通讯作者：
Khorana, A. A.
影响因子：
5.8
作者：
Cella, Chiara Alessandra;Di Minno, Giovanni;De Placido, Sabino
通讯作者：
De Placido, Sabino
影响因子：
45.3
作者：
Ay, Cihan;Vormittag, Rainer;Pabinger, Ingrid
通讯作者：
Pabinger, Ingrid
DOI：
10.1182/asheducation-2017.1.121
发表时间：
2017-12-01
影响因子：
3
作者：
Di Nisio, Marcello;Carrier, Marc
通讯作者：
Carrier, Marc
影响因子：
158.5
作者：
Detrano, Robert;Guerci, Alan D.;Kronmal, Richard A.
通讯作者：
Kronmal, Richard A.