Venous thromboembolism and cancer: Risks and outcomes
Venous thromboembolism and cancer: Risks and outcomes
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DOI：
10.1161/01.cir.0000078466.72504.ac
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发表时间：
2003-06-17
期刊：
影响因子：
37.8
通讯作者：
Levine, MN
中科院分区：
文献类型：
--
作者：
Lee, AYY;Levine, MN
癌症及其治疗是公认的静脉血栓栓塞 (VTE) 危险因素。有证据表明，绝对风险取决于肿瘤类型、癌症的阶段或范围以及抗肿瘤药物的治疗。此外，年龄、手术、制动和其他合并症特征也会影响血栓并发症的总体可能性，就像在非癌症患者中一样。遗传性血栓形成倾向在癌症和血栓形成患者中的作用尚不清楚，并且没有表明在癌症患者中进行这种情况的筛查。与血栓形成相关的最常见的恶性肿瘤是乳腺癌、结肠癌和肺癌，这反映了这些恶性肿瘤在普通人群中的患病率。根据疾病患病率进行调整后，与血栓并发症最密切相关的癌症是胰腺癌、卵巢癌和脑癌。特发性血栓形成可能是隐匿性恶性肿瘤的首发表现。然而，对 VTE 患者进行癌症强化筛查通常并不能提高生存率，而且通常没有必要。与癌症诊断的时间（VTE 之前或之后）无关，患有 VTE 的癌症患者的预期寿命相对较短，因为复发性 VTE 和癌症本身都会导致死亡。患有癌症和急性静脉血栓栓塞的患者长期服用抗凝剂会增加复发静脉血栓栓塞和出血的风险。最近的一项随机试验，低分子肝素与口服抗凝治疗对患有静脉血栓栓塞的癌症患者长期抗凝治疗的随机比较（CLOT）研究表明，低分子肝素可能是这组患者更好的治疗选择。人们正在积极研究抗凝剂的抗肿瘤作用，并取得了有希望的初步结果。
Cancer and its treatments are well-recognized risk factors for venous thromboembolism (VTE). Evidence suggests that the absolute risk depends on the tumor type, the stage or extent of the cancer, and treatment with antineoplastic agents. Furthermore, age, surgery, immobilization, and other comorbid features will also influence the overall likelihood of thrombotic complications, as they do in patients without cancer. The role of hereditary thrombophilia in patients with cancer and thrombosis is still unclear, and screening for this condition in cancer patients is not indicated. The most common malignancies associated with thrombosis are those of the breast, colon, and lung, reflecting the prevalence of these malignancies in the general population. When adjusted for disease prevalence, the cancers most strongly associated with thrombotic complications are those of the pancreas, ovary, and brain. Idiopathic thrombosis can be the first manifestation of an occult malignancy. However, intensive screening for cancer in patients with VTE often does not improve survival and is not generally warranted. Independently of the timing of cancer diagnosis ( before or after the VTE), the life expectancy of cancer patients with VTE is relatively short, because of both deaths from recurrent VTE and the cancer itself. Patients with cancer and acute VTE who take anticoagulants for an extended period are at increased risk of recurrent VTE and bleeding. A recent randomized trial, the Randomized Comparison of Low Molecular Weight Heparin versus Oral Anticoagulant Therapy for Long-Term Anticoagulation in Cancer Patients with Venous Thromboembolism ( CLOT) study, showed that low molecular weight heparin may be a better treatment option for this group of patients. The antineoplastic effects of anticoagulants are being actively investigated with promising preliminary results.