Targeting patients for anticoagulant prophylaxis trials in patients with cancer: Who is at highest risk?
Targeting patients for anticoagulant prophylaxis trials in patients with cancer: Who is at highest risk?
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DOI：
10.1016/s0049-3848(07)70128-7
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发表时间：
2007-01-01
影响因子：
7.5
通讯作者：
Wun, Ted
中科院分区：
文献类型：
--
作者：
White, Richard H.;Chew, Helen;Wun, Ted
导言：目前尚不清楚哪些癌症患者发生静脉血栓栓塞症(VTE)的风险最高。材料和方法：通过将加州癌症登记处数据库与1993-1999年间在加州公立医院住院的所有患者的出院记录联系起来，对癌症患者VTE的流行病学进行了调查。结果和结论：静脉血栓栓塞症的发病率最高的是以转移癌为主的患者，尤其是临床上侵袭性癌症，如胰腺癌，其一年死亡率较高。随着慢性内科合并症的增多，静脉血栓栓塞症的发生率也随之增加。静脉血栓栓塞症的发病率在确诊后的头几个月最高，并随着时间的推移而下降，即使癌症死亡率保持不变。胶质瘤患者在侵入性神经外科手术后发生VTE的几率非常高，而接受大手术的实体癌患者与没有接受大手术的患者相比，发生VTE的风险更高。与年龄、种族、性别、初始癌症阶段和癌症诊断后时间相匹配的没有VTE的癌症患者相比，发生VTE与显著缩短生存期有关。VTE对生存率的影响在最初诊断为局部或区域性实体癌的患者中最大，因为VTE与转移性疾病的出现有关。如果考虑癌症患者的初级血栓预防，治疗应在癌症诊断后立即开始，并应针对最初具有生物学侵袭性且最初是转移性癌症的患者和/或有多种慢性并存疾病的患者。二次血栓预防应该针对有证据表明正在进行的活动性恶性肿瘤的患者。神经胶质瘤患者在侵入性神经外科手术后的3个月内处于非常高的风险中。(C)2007 Elsevier B.V.保留所有权利。
Introduction: It is not clear which cancer patients are at highest risk for developing venous thromboembolism (VTE).Materials and Methods: The epidemiology of VTE in cancer patients was investigated by linking the California Cancer Registry database to the discharge records of all patients hospitalized in California public hospitals between 1993-1999. Nineteen types of cancer were studied, four in detail.Results and Conclusions: The incidence of VTE was highest in patients who presented with metastatic cancer, particularly clinically aggressive cancers associate with a high one-year mortality rate, such as pancreatic cancer. The incidence of VTE increased as the number of chronic medical co-morbid conditions increased. The incidence of VTE was highest in the first few months after diagnosis, and decreased over time, even when the death rate due to cancer remained constant. Patients with glioma had a very high incidence of VTE after invasive neurosurgery, whereas patients with solid cancers who underwent major surgery had a tower risk of developing VTE compared to patients who did not undergo major surgery. Development of VTE was associated with significantly shortened survival compared to cancer patients without VTE matched for age, race, sex, initial cancer stage and time after cancer diagnosis. This effect of VTE on survival was greatest in patients initially diagnosed with local or regional stage solid cancer as VTE was associated with emergence of metastatic disease.If primary thromboprophylaxis of cancer patients is considered, treatment should begin immediately after cancer diagnosis, and it should be targeted toward patients who have a biologically aggressive cancer that is initially metastatic and/or toward patients who have several chronic co-morbid conditions. Secondary thromboprophylaxis should be targeted toward patients who have evidence of an ongoing active malignancy. Glioma patients are at very high risk in the 3 month period immediately after invasive neurosurgery. (c) 2007 Elsevier B.V. All rights reserved.