Guideline : Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
Guideline : Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
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2007
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通讯作者：
G. Lyman;A. Khorana;A. Falanga;D. Clarke‐Pearson;C. Flowers;M. Jahanzeb;A. Kakkar;N. Kuderer;M. Levine;H. Liebman;D. Mendelson;G. Raskob;M. Somerfield;P. Thodiyil;D. Trent;C. Francis
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作者：
G. Lyman;A. Khorana;A. Falanga;D. Clarke‐Pearson;C. Flowers;M. Jahanzeb;A. Kakkar;N. Kuderer;M. Levine;H. Liebman;D. Mendelson;G. Raskob;M. Somerfield;P. Thodiyil;D. Trent;C. Francis
目的制定抗凝治疗在预防和治疗癌症患者静脉血栓栓塞（VTE）中的指南建议。方法由内容和方法学专家组成的专家组对有关癌症患者静脉血栓栓塞预防和治疗的医学文献进行全面系统的综述。在对结果进行讨论后，专家组起草了在恶性疾病患者中使用抗凝剂的建议。结果回顾性分析了原发性和继发性静脉血栓栓塞的药物预防、手术预防、静脉血栓栓塞治疗以及抗凝治疗对癌症患者生存的影响的随机对照试验结果。提出了关于预防住院、门诊和手术癌症患者以及已确诊VTE的患者发生VTE的建议，以及在未发生VTE的癌症患者中使用抗凝剂以提高生存率的建议。结论美国临床肿瘤学会VTE指南专家组建议：（1）所有住院癌症患者在无出血或其他禁忌症的情况下，均应考虑使用抗凝剂预防VTE，（2）不建议对非卧床癌症患者使用抗凝剂进行常规预防，但沙利度胺或来那度胺除外;（3）对于因恶性疾病接受大手术的患者，应考虑进行药物血栓预防;（4）低分子量肝素是已确诊VTE的癌症患者的初始和持续治疗的首选药物;（5）抗凝剂对癌症患者存活率的影响需要进一步研究，目前尚不推荐。J Clin Oncol 25：5490-5505.© 2007美国临床肿瘤学会
Purpose To develop guideline recommendations for the use of anticoagulation in the prevention and treatment of venous thromboembolism (VTE) in patients with cancer. Methods A comprehensive systematic review of the medical literature on the prevention and treatment of VTE in cancer patients was conducted and reviewed by a panel of content and methodology experts. Following discussion of the results, the panel drafted recommendations for the use of anticoagulation in patients with malignant disease. Results The results of randomized controlled trials of primary and secondary VTE medical prophylaxis, surgical prophylaxis, VTE treatment, and the impact of anticoagulation on survival of patients with cancer were reviewed. Recommendations were developed on the prevention of VTE in hospitalized, ambulatory, and surgical cancer patients as well as patients with established VTE, and for use of anticoagulants in cancer patients without VTE to improve survival. Conclusion Recommendations of the American Society of Clinical Oncology VTE Guideline Panel include (1) all hospitalized cancer patients should be considered for VTE prophylaxis with anticoagulants in the absence of bleeding or other contraindications; (2) routine prophylaxis of ambulatory cancer patients with anticoagulation is not recommended, with the exception of patients receiving thalidomide or lenalidomide; (3) patients undergoing major surgery for malignant disease should be considered for pharmacologic thromboprophylaxis; (4) low molecular weight heparin represents the preferred agent for both the initial and continuing treatment of cancer patients with established VTE; and (5) the impact of anticoagulants on cancer patient survival requires additional study and cannot be recommended at present. J Clin Oncol 25:5490-5505. © 2007 by American Society of Clinical Oncology