Abstract

Cancer is a leading cause of venous thromboembolism (VTE), which contributes to significant morbidity and mortality in these patients. Increased thrombotic risk in cancer patients is modified by tumor-specific biology, disease-directed interventions, and individual comorbidities. Risk stratification for prophylaxis and treatment requires regular re-evaluation of these factors, which can be facilitated by validated prediction tools. This review also discusses large clinical trial data (SELECT-D, HOKUSAI-VTE, ADAM VTE, CARAVAGGIO) demonstrating that direct oral anticoagulants (DOACs) are effective in the treatment of cancer-associated VTE, with comparable efficacy to the traditional choice of low molecular weight heparin. In the prophylactic setting derived from patients with cancer with increased VTE risk, DOACs also reduced the incidence of VTE with only modest increases in bleeding risk. The ease of DOAC administration and acceptable risk profile in the carefully selected patient make them an appealing choice for anticoagulation. In instances where the risk of gastrointestinal bleeding is of concern, apixaban, in particular, may still be a suitable option in place of LMWH. These improvements in our anticoagulation approach to cancer-associated VTE are well-timed to accompany the recent advances in disease-directed therapies that are enabling patients to live longer with cancer and therefore at increased risk of complications such as VTE.

摘要

癌症是静脉血栓栓塞 (VTE) 的主要原因，这会导致这些患者的发病率和死亡率显着升高。癌症患者血栓形成风险的增加会受到肿瘤特异性生物学、疾病导向干预和个体合并症的影响。预防和治疗的风险分层需要定期重新评估这些因素，这可以通过经过验证的预测工具来促进。本综述还讨论了大型临床试验数据（SELECT-D、HOKUSAI-VTE、ADAM VTE、CARAVAGGIO），证明直接口服抗凝剂 (DOAC) 可有效治疗癌症相关 VTE，其疗效与传统选择的低剂量抗凝剂相当。分子量肝素。在来自 VTE 风险增加的癌症患者的预防性环境中，DOACs 还降低了 VTE 的发生率，但出血风险仅略有增加。DOAC 给药的简便性和在精心挑选的患者中可接受的风险状况使它们成为抗凝治疗的有吸引力的选择。在担心胃肠道出血风险的情况下，特别是阿哌沙班可能仍然是替代 LMWH 的合适选择。我们针对癌症相关 VTE 的抗凝方法的这些改进恰逢其时，与疾病导向疗法的最新进展相得益彰，这些疗法使患者因癌症而活得更久，从而增加了 VTE 等并发症的风险。在担心胃肠道出血风险的情况下，特别是阿哌沙班可能仍然是替代 LMWH 的合适选择。我们针对癌症相关 VTE 的抗凝方法的这些改进恰逢其时，与疾病导向疗法的最新进展相得益彰，这些疗法使患者因癌症而活得更久，从而增加了 VTE 等并发症的风险。在担心胃肠道出血风险的情况下，特别是阿哌沙班可能仍然是替代 LMWH 的合适选择。我们针对癌症相关 VTE 的抗凝方法的这些改进恰逢其时，与疾病导向疗法的最新进展相得益彰，这些疗法使患者因癌症而活得更久，从而增加了 VTE 等并发症的风险。