Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients.
Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients.
复制标题
癌症对抗凝患者围手术期血栓栓塞和出血的影响。
DOI：
10.1093/annonc/mds058
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Heit,JA
中科院分区：
文献类型：
--
作者：
Tafur,AJ;Wysokinski,WE;McBane,RD;Wolny,E;Sutkowska,E;Litin,SC;Daniels,PR;Slusser,JP;Hodge,DO;Heit,JA
背景：活动性癌症患者经常长期抗凝治疗，并且经常需要中断这种治疗以进行侵入性操作。癌症对围手术期血栓栓塞（TE）和大出血的影响是未知的。患者和methods 2182例连续患者引用围手术期抗凝治疗（2484程序）使用标准化的协议进行了后续的时间，估计3个月的TE，大出血和生存率分层抗凝适应症。对于每种适应症，我们测试了活动性癌症和桥接肝素治疗作为TE和大出血的潜在预测因子。结果与非癌症患者相比，活动性癌症患者（n= 493）有更多的静脉血栓栓塞（VTE）并发症（1.2%与0.2%;P= 0.001）、大出血（3.4%与1.7%;P= 0.02）和生存率降低（95%与99%;P< 0.001）。在活动性癌症患者中，只有那些因静脉血栓栓塞而长期抗凝的患者围手术期静脉血栓栓塞（2%对0.16%;P= 0.002）和大出血（3.7%对0.6%;P< 0.001）的发生率较高。肝素桥接增加了癌症患者的大出血率（5%对1%;P= 0.03），而不影响VTE率（0.7%对1.4%，P= 0.50）。这些患者的围手术期抗凝治疗需要特别注意，以减少这些并发症。
BackgroundPatients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known.Patients and methodsTwo thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding.ResultsCompared with patients without cancer, active cancer patients (n= 493) had more venous thromboembolism (VTE) complications (1.2 % versus 0.2 % ;P= 0.001), major bleeding (3.4 % versus 1.7 % ;P= 0.02) and reduced survival (95 % versus 99 % ;P< 0.001). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2 % versus 0.16 % ;P= 0.002) and major bleeding (3.7 % versus 0.6 % ;P< 0.001). Bridging with heparin increased the rate of major bleeding in cancer patients (5 % versus 1 % ;P= 0.03) without impacting the VTE rate (0.7 % versus 1.4 % ,P= 0.50).ConclusionsCancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.