Abstract：
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
摘要：
癌症患者发生静脉血栓栓塞（VTE）的风险显著增加，由于恶性疾病本身的影响以及某些抗癌药物对止血的影响。对于首次发作的静脉血栓栓塞和复发都是如此。癌症患者VTE复发的诊断和管理面临着特殊的挑战，这些都在本文中进行了回顾，基于对过去十年发表的相关科学文献的系统回顾。此外，目前还不确定静脉血栓栓塞的诊断算法，主要在未经治疗的非癌症患者中验证，在抗凝癌症患者中也有效：现有数据表明，临床决策规则和D-二聚体测试在这种临床环境中表现不佳。在癌症患者中，CT肺动脉造影和静脉超声分别是诊断肺栓塞和深静脉血栓的最可靠的诊断工具。静脉血栓栓塞症的治疗选择包括低分子量肝素（治疗剂量或增加剂量），磺达肝素或口服直接因子Xa抑制剂。治疗的选择应考虑到性质（肺栓塞或VTE）和复发事件的严重程度，相关的出血风险，目前的抗凝治疗(类型，剂量,依从性和可能的药物-药物相互作用)和癌症进展。
