PDF(Pubmed)
Abstract：
Cancer is a known risk factor for venous thromboembolism (VTE). The wider adoption of immunotherapy and anti-angiogenic drugs in recent years have increased this risk further. Central venous catheters (CVCs) are widely used access devices utilized to deliver infusion therapy, mostly in ambulatory settings. The endothelial injury associated with the use of these catheters adds to the risk of VTE to already high-risk patients. The introduction of direct oral anticoagulants (DOACs), with its proven efficacy and safety in multiple clinical indications, have renewed the attention to VTE prophylaxis in cancer patients with CVC. Several clinical trials and meta-analyses had shown that both apixaban and rivaroxaban are effective in lowering the risk of VTE, without increasing the risk of bleeding. Several risk assessment models (RAM) have utilized patient-related, tumor-related, and treatment-related factors, in addition to widely available biomarkers, like Hemoglobin (Hb) level, white blood cell (WBC) and platelets counts to stratify patients into two or three VTE risk levels. In this manuscript, we review the published clinical trials and meta-analyses that attempted to study the efficacy and safety of anticoagulants, mostly the DOACs, in cancer patients with CVCs. We will also propose a practical risk-directed approach to enhance VTE prophylaxis rate.
摘要：
癌症是静脉血栓栓塞（VTE）的已知危险因素。近年来，免疫疗法和抗血管生成药物的广泛采用进一步增加了这种风险。中心静脉导管（CVC）是广泛使用的接入设备，用于提供输液治疗，主要是在门诊。与使用这些导管相关的内皮损伤增加了已经高危患者发生VTE的风险。直接口服抗凝剂（DOACs）的引入，凭借其在多种临床适应症中被证明的有效性和安全性，再次关注CVC癌症患者的VTE预防。多项临床试验和荟萃分析显示，阿哌沙班和利伐沙班均可有效降低VTE的风险。不会增加出血的风险。几种风险评估模型(RAM)利用了与患者相关的，肿瘤相关，和治疗相关因素，除了广泛可用的生物标志物，如血红蛋白（Hb）水平，白细胞（WBC）和血小板计数将患者分为2或3个VTE风险水平。在这份手稿中,我们回顾了已发表的临床试验和荟萃分析，这些临床试验和荟萃分析试图研究抗凝剂的疗效和安全性，主要是DOAC,在患有CVC的癌症患者中。我们还将提出一种切实可行的风险导向方法来提高VTE的预防率。
