肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件.ppt

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1、,目前已经证实恶性肿瘤与TE之间关系密切,恶性肿瘤患者通常处于高状态,与非恶性肿瘤患者相比,其发生TE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T通常初始使用低分子肝素(LMMH)进行抗凝台疗,长期抗凝是否可转换为华法林?亦或更换为新型抗凝药?,主要内容肿瘤患者VTE初始治疗方案肿瘤患者TE长期治疗肝素VS华法林c帅患7长0GN法林总结,参考文献1.High Incidence of Thromboembolic Events in Patients Treated With Cisplatin-Based ChemotherapyLarge Retrospective

2、 Analysis J Clin Oncol.2019,29(25):34662.Venous thromboembolism in the cancer outpatient setting:contemporary rates and predictors in theUnited StatesJ.Cancer.2019,1193):648-55.3.Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancerICochrane Database Syst Rev,

3、2019,8(74.Oral rivaroxaban versus standard therapy for the treatment of symvenous thromboembolisma pooled analysis of the EINSTEIN-DVT and PE randomized studiesJ.Thromb J 2019:11:215.Direct oral anticoagulants in patients with VTE and cancer:a systematic review and meta-analysisChest.2019:147(2475-4

4、846.Pros and cons of new oral anticoagulants in the treatment of venous thromboembolism in patientsith cancerJ.Inter Emerg Med.2019,10(6):651-656.,流行病学Table 2.Overall Incidence of Thromboembolic Events(Nm 932)No.ofThromboembolic EventThrombosisTypes of thromboses(n m 169DVT alone433497PE alone254DVT

5、+PEArterial thrombosis alone83DVT arterial thrombosis30Tye to TEE(days)Fig 1.Tinin pstients who develped a thrembcemacleven:TEEHigh Incidence of Thromboembolic Events in Patients Treated With Cisplatin-Based Chemotherapy:A,流行病学 A Caoer pert1734口 orto Wa1728ORTOnFigure 2.Inc dence of veneus thromboem

6、bolism(VTE isillustrated for the cancer and noncancer cohorts.An asteriskindicates 0001,DVT incicates deep vein thrombosis:PE Figure 3.The Incidence of venous thrompoembo ism is illuspulmonary embolism.rated according to cancer type.2.Venous thromboembolism in the cancer outpatient setting:contempor

7、ary rates and predictors in the United StatesJcancer.:2019,193648-5,肿癌患者VT治疗方案选择2019ASC021IESMOclinical practice quide ines 73m 262w112 Ww wz?OURNAL OF CLINICAL ONCOLOGY A5CO SPECIAL ARTICLEManagement of venous thromboembolism(TE)incancer patients:ESMO Clinical Practice GuidelinesVenous Thromboembol

8、ism Prophylaxis and TreatOncology Clinical Practice Guideline Update 2019I Esrt-hmcves1 IE CHESTAntithrombotic Therapy for VTE Disease omunCHEST Guideline and Expert Panel ReportCancer-AssociatedMm的共然柳D幽做的唱烈mVenous Thromboembolic Disease线心心战心三心2019ACCP2019NCCN,2019EMSO2019ASCO2019CNNC2019ACCPal trea

9、tmeLMWH is recommendedLMWH,UFHfor the initial 5 to 10 daysLMWH over vKaCrcl25-30 mL,UFH of treatment of Vte as LMWH,UFH or FXaor lmwh with antiwell as for long-termantagonists according tois recommendeclinical situationdoxaban(2C)at first 3monthsLong term treatmentextended anticoagulanttherapy(no sc

10、heduled stopUse of novel oralLMWH is preferred.date)over 3 months of75%0-80%c of the initiadose for 6 months ofIndefiniteerapy(IB),or have acurrently recommendedLMWH is safe and more for patients withanticoagulation inhigh bleeding risk,gest extendedeffective than VKA.(1,A)malignancy and VTEcancer o

11、r persistent risk anticoagulant therapy(nofactorsscheduled stop date)over 3months of therapy(2B),肿瘤患者VTE指南推荐治疗方案总结肿瘤患者发生VTE时起始治疗各指南均推荐LMWH。长期治疗药物选择方面除ASCO指南说明无法使用LMWH时可选择VKA,其余均说明LMWH优于VKA。活动性肿瘤或血栓诱因持续存在时,疗程不确定,长期抗凝优于短期抗凝(3个月)。,肿瘤患者VTE长期治疗 LMWH VS华法林0,033 records identified through55 additional reco

12、rd identified throughdatabase searchingother sources9559 records after duplicates removed54 full-text articles excluded,with reasons4-unavailable data for cancersubgroup:1=case9559 records screenedseries:15=review 4=retrospectivetudy:2=protocol:6=observationstudy:4=nonrandomizedtrial:4=no cancer65 f

13、ull-text articles assessed for eligibilitypatients included:1=only one cancer patientincluded:2-no relevant outcome1=different durations of intervention10 studies included in qualitative synthesis(11 reports)10 studies included in qualitative synthesis(meta-analysis)3.Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer.Cochrane Database SystRev,20198(7,