癌症相关血栓形成(CAT)是一种破坏性的癌症并发症,可显著影响患者的健康和生活。CAT的发病率约为20%,每5名癌症患者中就有1名将每年发展成CAT。的确,CAT可以促进肺栓塞和深静脉血栓形成,导致发病率和死亡率增加,从而显著影响生存率。CAT还可以引起抗癌治疗的延迟或停止,这可能导致患者缺乏治疗效果和高昂的费用,机构,和社会。目前的指南提倡直接口服抗凝剂(DOAC)作为CAT的一线抗凝剂选择。与低分子量肝素(LMWHs)相比,DOAC的优势在于它们通常具有口服给药途径,不需要实验室监测,并具有更可预测的抗凝作用。然而,在血小板减少症患者中,肾功能衰竭,或者那些接受有潜在药物-药物相互作用的抗癌方案的人,LMWH仍然是护理的支柱。目前抗凝剂的主要局限性与出血风险(BR)有关,对于DOAC和LMWH。具体来说,DOAC与胃肠道和泌尿生殖系统癌症中的高BR相关。在这个充满挑战的场景中,abelacimab,抗因子XI剂,由于其“止血节省”效果,可以代表CAT管理的可行选择。abelacimab的安全概况可用于患有活动性恶性肿瘤和CAT的患者,因为经常需要长期抗凝治疗。两项正在进行的国际III期试验(Aster和Magnolia)将abelacimab与标准护理(即,CAT患者的阿哌沙班和CAT和高BR患者的达肝素,分别)。Abelacimab是一种新的,有吸引力的抗凝剂,用于CAT的管理,特别是在有静脉血栓栓塞和高BR的活动性癌症患者的阴险和危重情况下。这篇叙述性综述的目的是讨论DOAC和LMWH在CAT治疗中表现的最新证据,并关注abelacimab在CAT及其有希望的相关临床试验中的潜在作用。
Cancer-associated thrombosis (CAT) is a devastating complication of cancer that can significantly impact a patient\'s health and life. The incidence of CAT is approximately 20%, and 1 in 5 cancer patients will develop CAT annually. Indeed, CAT can promote pulmonary embolism and deep vein thrombosis, leading to increased morbidity and mortality that dramatically impact survival. CAT can also provoke delay or discontinuation of anticancer treatment, which may result in a lack of treatment efficacy and high costs for patients, institutions, and society. Current guidelines advocate direct oral anticoagulants (DOACs) as the first-line anticoagulant option in CAT. Compared to low-molecular-weight-heparins (LMWHs), DOACs are advantageous in that they typically have an oral route of administration, do not require laboratory monitoring, and have a more predictable anticoagulant effect. However, in patients with thrombocytopenia, renal failure, or those receiving anticancer regimens with potential for drug-drug interactions, LMWH is still the mainstay of care. The main limitation of current anticoagulant agents is related to bleeding risk (BR), both for DOACs and LMWHs. Specifically, DOACs have been associated with high BR in gastrointestinal and genitourinary cancers. In this challenging scenario, abelacimab, an anti-factor XI agent, could represent a viable option in the management of CAT due to its \"hemostasis sparing\" effect. The safe profile of abelacimab could be useful in patients with active malignancy and CAT, as long-term anticoagulant therapy is often required. Two ongoing international phase III trials (Aster and Magnolia) compare abelacimab with the standard of care (i.e., apixaban in patients with CAT and dalteparin in those with CAT and high BR, respectively). Abelacimab is a new and attractive anticoagulant for the management of CAT, especially in the insidious and critical scenario of active cancer patients with venous thromboembolism and high BR. The aim of this narrative
review is to discuss the updated evidence on the performance of DOACs and LMWHs in the treatment of CAT and to focus on the potential role of abelacimab in CAT and its promising associated clinical trials.