API-CAT试验对癌症相关静脉血栓栓塞的扩展二级预防的意义:专家小组的指导

IF 2.4 4区 医学 Q2 HEMATOLOGY
Florian Langer, Christina Hart, Kai-Michael Klima, Sandra Marten, Katja S Mühlberg, Christian Pfrepper, Rupert Bauersachs
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引用次数: 0

摘要

静脉血栓栓塞(VTE)是实体瘤和血液系统恶性肿瘤的一种日益常见的并发症,显著增加了发病率和死亡率。基于随机对照试验的临床实践指南建议,对于急性癌症相关性静脉血栓栓塞患者,直接口服Xa因子抑制剂(DXIs)或低分子肝素(LMWH)治疗抗凝治疗3 - 6个月。尽管对于持续性活动性癌症患者应考虑延长继发性静脉血栓栓塞预防,但直到最近才对持续抗凝治疗的类型、强度和持续时间进行了严格的研究。在非癌症患者中,低剂量的dxi(阿哌沙班2.5 mg BID或利伐沙班10 mg OD)是预防治疗前6个月后静脉血栓栓塞复发的首选方案。最近发表的API-CAT试验比较了低剂量和全剂量阿哌沙班对1766例活动性癌症患者继发性静脉血栓栓塞的预防作用。在12个月的时间里,低剂量阿哌沙班与全剂量阿哌沙班相比具有相似的疗效,但显著提高了安全性,静脉血栓栓塞复发和主要或临床相关的非主要出血的累积发生率分别为2.1%和2.8%(调整亚危险比[sHR]: 0.76;95%置信区间[CI]: 0.41-1.41;P = 0.03为优势)。基于这些发现,对于大多数持续性活动性癌症患者,建议使用低剂量的DXIs,最好是阿哌沙班2.5 mg BID进行继发性静脉血栓栓塞预防。为了促进临床实践中的明智决策,我们提供了专家共识的标准,证明停止抗凝或需要继续全剂量抗凝。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implications of the API-CAT Trial for Extended Secondary Prophylaxis of Cancer-associated Venous Thromboembolism: Guidance from an Expert Panel.

Venous thromboembolism (VTE) is an increasingly frequent complication of solid tumors and hematological malignancies, significantly contributing to morbidity and mortality. In patients with acute cancer-associated VTE, therapeutic anticoagulation with direct oral factor Xa inhibitors (DXIs) or low-molecular-weight heparin (LMWH) for 3 to 6 months is recommended by clinical practice guidelines based on randomized controlled trials. Although extended secondary VTE prophylaxis should be considered in patients with persisting active cancer, the type, intensity, and duration of continued anticoagulation have not been rigorously studied until recently. In non-cancer patients, low-dose DXIs (apixaban 2.5 mg BID or rivaroxaban 10 mg OD) are the preferred options to prevent recurrent VTE beyond the first 6 months of treatment. The recently published API-CAT trial compared low-dose with full-dose apixaban for extended secondary VTE prophylaxis in 1,766 patients with active cancer. Over a 12-month period, low-dose apixaban was associated with similar efficacy, but significantly improved safety compared with full-dose apixaban, with cumulative incidence rates of recurrent VTE and major or clinically relevant non-major bleeding of 2.1% versus 2.8% (adjusted subhazard ratio [sHR]: 0.76; 95% confidence interval [CI]: 0.41-1.41; p < 0.001 for noninferiority) and 12.1% versus 15.6% (adjusted sHR: 0.75; 95% CI: 0.58-0.97; p = 0.03 for superiority), respectively. Based on these findings, extended secondary VTE prophylaxis with low-dose DXIs, preferably apixaban 2.5 mg BID, is proposed for most patients with persisting active cancer. To facilitate informed decision-making in clinical practice, we provide an expert consensus on criteria that either justify cessation of anticoagulation or require continued full-dose anticoagulation.

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来源期刊
Hamostaseologie
Hamostaseologie HEMATOLOGY-
CiteScore
5.50
自引率
6.20%
发文量
62
审稿时长
6-12 weeks
期刊介绍: Hämostaseologie is an interdisciplinary specialist journal on the complex topics of haemorrhages and thromboembolism and is aimed not only at haematologists, but also at a wide range of specialists from clinic and practice. The readership consequently includes both specialists for internal medicine as well as for surgical diseases.
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