Incidental venous thromboembolism: is anticoagulation indicated?
Incidental venous thromboembolism: is anticoagulation indicated?
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DOI：
10.1182/asheducation-2017.1.121
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发表时间：
2017-12-01
影响因子：
3
通讯作者：
Carrier, Marc
中科院分区：
文献类型：
--
作者：
Di Nisio, Marcello;Carrier, Marc
癌症患者发生静脉血栓栓塞（VIE）的风险很高，其中约一半是偶然发现的。偶发性VIE的预后似乎与症状性事件相似，在该患者人群中，复发性VTE的发生率非常高。在没有主要禁忌症的情况下，对于偶发近端深静脉血栓形成以及累及多个亚段或更近端肺动脉的偶发肺栓塞，通常建议使用低分子量肝素抗凝治疗3至6个月。在定期重新评估出血和复发性VTE的风险因素后，应根据具体情况评估是否将治疗延长至3至6个月以上，同时还应考虑患者的偏好。不伴深静脉血栓形成的单次偶发亚段肺栓塞的临床相关性尚不确定，也可考虑采取观察方法或缩短抗凝疗程以最大限度地降低出血风险。初步证据表明，抗凝治疗可能对伴有远端深静脉血栓形成或内脏静脉血栓形成的癌症患者有益。
Patients with cancer have a high risk of venous thromboembolism (VIE) and about one-half of these events are incidentally detected. The prognosis of incidental VIE appears to be similar to symptomatic events, with comparably high rates of recurrent VTE in this patient population. In the absence of major contraindications, anticoagulant treatment with low-molecular-weight heparin for 3 to 6 months is generally recommended for incidental proximal deep vein thrombosis as well as for incidental pulmonary embolism that involves multiple subsegmental or more proximal pulmonary arteries. The decision of whether to extend treatment beyond 3 to 6 months should be evaluated on a case-by-case basis after periodic reassessment of the risks factors for bleeding and recurrent VTE while also taking into account patient preferences. The clinical relevance of a single incidental subsegmental pulmonary embolism without concomitant deep vein thrombosis is uncertain and either a watchful approach or a shorter course of anticoagulation to minimize the bleeding risk may also be considered. Preliminary evidence suggests that anticoagulation treatment may be beneficial for cancer patients with incidental distal deep vein thrombosis or incidental splanchnic vein thrombosis.