Prevention and treatment of cancer associated venous thromboembolism - interdisciplinary consensus.

Q4 Medicine

Vnitrni lekarstvi Pub Date : 2022-06-22 DOI:10.36290/vnl.2022.047

I. Vacula, Z. Rusiňáková, D. Čelovská, P. Jackuliak, J. Slopovský, P. Palacka, M. Moščovič, S. Špánik, J. Staško, Alexander Wild, A. Bátorová, Juraj Ma Arič

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Abstract

The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.

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癌症相关静脉血栓栓塞症的预防和治疗——跨学科共识。

直接口服抗凝剂（DOACS）在肿瘤学患者静脉血栓栓塞症（CAVTE）的一级和二级预防中的数据和经验不断增加，最近导致一些国际指南发生了变化。我们在斯洛伐克共和国的情况下反映了这些变化。在CAVTE的初级预防中，我们识别肿瘤手术患者和非手术患者：住院患者和门诊患者。低分子量肝素在CAVTE的初级预防中仍然占主导地位。关于CAVTE的治疗和二级预防，我们建议始终考虑使用DOAC的可能性，因为它们被证明不劣于LMWH。然而，对于所有临床不稳定、出血风险高和/或与全身治疗相互作用的患者，LMWH应优先于DOAC和华法林（VKA）。主要发生在胃肠道上部管腔内肿瘤和泌尿生殖系统肿瘤出血风险高的患者中。至于缺乏数据，LMWH在中枢神经系统原发性肿瘤和转移性疾病以及血液肿瘤患者中仍然是首选。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vnitrni lekarstvi Medicine-Internal Medicine

CiteScore

0.50

自引率

0.00%

发文量

104

期刊介绍： Vnitřní lékařství je tiskovým orgánem České internistické společnosti České lékařské společnosti Jana Evangelisty Purkyně a Slovenskej internistickej spoločnosti Slovenskej lekárskej spoločnosti. Je vydáván nepřetržitě od roku 1955. Časopis vychází jako měsíčník, tedy 12krát do roka a podle potřeby jsou v běžném ročníku vydávána jeho suplementa, která jsou obsahově zaměřena k určitému tématu. Tematicky je časopis zaměřen široce na oblast interní medicíny se zvláštní pozorností ke kardiologii, diabetologii a poruchám metabolizmu.