肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件

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1、 肿瘤相关VTE治疗研究进展前 言 目前已经证实恶性肿瘤与VTE之间关系密切，恶性肿瘤 患者通常处于高凝状态，与非恶性肿瘤患者相比，其发生VTE的风险更高。血栓栓塞事件已经成为肿瘤患者的第二大死因。 肿瘤患者发生VTE通常初始使用低分子肝素（LMWH）进行抗凝治疗，长期抗凝是否可转换为华法林？亦或更换为新型抗凝药？04020103主要内容肿瘤患者VTE初始治疗方案肿瘤患者VTE长期治疗肝素VS华法林肿瘤患者VTE长期治疗DOACs VS华法林总结参 考文 献 1.High Incidence of Thromboembolic Events in Patients Treated With C

2、isplatin-Based Chemotherapy: A Large Retrospective Analysis J.J Clin Oncol.2011,29(25):3466-73. 2.Venous thromboembolism in the cancer outpatient setting: contemporary rates and predictors in the United StatesJ. Cancer. 2013 ,119(3):648-55.3. Anticoagulation for the long-term treatment of venous thr

3、omboembolism in patients with cancerJ. Cochrane Database Syst Rev ,2014,8(7).4. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studiesJ. Thromb J 2013; 11:21.5. Direct oral anticoagulants in pa

4、tients with VTE and cancer: a systematic review and meta-analysisJ. Chest. 2015;147(2):475-484. 6. Pros and cons of new oral anticoagulants in the treatment of venous thromboembolism in patients with cancerJ.Inter Emerg Med.2015,10(6):651-656.流 行 病 学1.High Incidence of Thromboembolic Events in Patie

5、nts Treated With Cisplatin-Based Chemotherapy: A Large Retrospective Analysis J.J Clin Oncol.2011,29(25):3466-3473.肿瘤患者VTE治疗方案选择2011EMSO2014ASCO2016CNNC2016ACCPInitial treatmentLMWH，UFH.Crcl 2530 ml, UFH or LMWH with anti-Xa activity monitoring is recommended I, A LMWH is recommended for the initial

6、 5 to 10 days of treatment of VTE as well as for long-term secondary prophylaxis for at least 6 months. LMWH,UFH or FXa antagonists according to patients characteristics and clinical situation.LMWH over VKA therapydabigatran,rivar-oxaban,apixaban or edoxaban(2C) at first 3 months.Long term treatment

7、75%-80% of the initial dose for 6 months of LMWH is safe and more effective than VKA.(I,A)Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. LMWH is preferred.Indefinite anticoagulation in patients with active cancer or persistent risk factors.extende

8、d anticoagulant therapy (no scheduled stop date) over 3 months of therapy (1B), or have a high bleeding risk, we suggest extended anticoagulant therapy (no scheduled stop date) over 3 months of therapy (2B) 肿瘤患者发生肿瘤患者发生VTE时起始治疗各指南均推荐时起始治疗各指南均推荐LMWH。 长期长期治疗药物选择方面除治疗药物选择方面除ASCO指南说明无法使用指南说明无法使用LMWH时可选择

9、时可选择VKA，其余均说明，其余均说明LMWH优于优于VKA。 活动性活动性肿瘤或血栓诱因持续存在时，疗程不确定，肿瘤或血栓诱因持续存在时，疗程不确定，长长期抗凝期抗凝优于短期抗凝（优于短期抗凝（3个月）。个月）。肿瘤患者VTE指南推荐治疗方案总结肿瘤患者VTE长期治疗LMWH VS华法林3. Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev ,2014,8(7).10,033 records iden

10、tified through database searching55 additional record identified through other sources9559 records after duplicates removed9559 records screened65 full-text articles assessed for eligibility10 studies included in qualitative synthesis(11 reports)10 studies included in qualitative synthesis(meta-anal