ESMO指南在预防和治疗癌症相关血栓中的实际应用:挑战和观点。

IF 4.7 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Grigoris Gerotziafas, Elmina Lefkou, Peter Marschang, Matija Kozak, Benilde Cosmi, Agata Stanek
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引用次数: 0

摘要

癌症相关血栓形成(CAT)是癌症患者死亡的第二大原因,显著影响生活质量、生存和医疗保健费用。本综述总结了2023年ESMO关于CAT预防和治疗指南的主要建议,并通过一个现实案例加以说明,并审查了实施的障碍。CAT风险是多因素的,受肿瘤相关因素(类型、分期、诊断后时间)、治疗暴露(抗癌药物、手术、中心静脉导管)和合并症的影响,由“4TS”规则捕获。新兴的生物标志物(如d -二聚体、凝血酶生成、凝血组基因)和致癌突变可能会细化风险分层。指南建议使用Khorana评分、COMPASS-CAT或Vienna-CATS等模型进行常规评估,其中COMPASS-CAT对乳腺癌、肺癌、卵巢癌或结肠癌患者的预测准确性更高。对于高危门诊患者,建议进行长达6个月的血栓预防治疗,此后定期重新评估风险。CAT的治疗倾向于低分子肝素或直接口服抗xa药物(阿哌沙班、依多沙班、利伐沙班),附带静脉血栓栓塞的处理与症状事件类似。API-CAT研究支持低剂量阿哌沙班(2.5 mg,每日2次[BID])作为一种更安全的长期治疗。筛选抗磷脂抗体指导治疗策略。优化抗血栓治疗的主要挑战包括肾功能损害、血小板减少症和治疗依从性。口服抗xa药物可改善生活质量。有效的CAT管理需要个性化护理、强有力的医患沟通和教育。实现仍然不是最优的。缩小差距需要国家战略,促进卫生服务提供者培训、患者赋权、电子卫生应用、公平获取和专门的CAT门诊诊所,以提供持续的个性化护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Real-life application of the European Society for Medical Oncology guidelines for the prevention and treatment of cancer-associated thrombosis: challenges and perspectives.

Cancer‑associated thrombosis (CAT) is the second leading cause of death in cancer patients, significantly affecting their quality of life, survival, and health care costs. This review summarizes key recommendations from the 2023 European Society for Medical Oncology guidelines on CAT prevention and treatment, illustrated by a real‑world case, and examines barriers to their implementation. CAT risk is multifactorial, shaped by tumor‑related factors (type, stage, time since diagnosis), treatment exposures (anticancer agents, surgery, central venous catheters), and comorbidities, captured by the "4TS" rule. Emerging biomarkers (eg, D‑dimer, thrombin generation, coagulome genes) and oncogenic mutations may refine risk stratification. The guidelines recommend routine assessment using models such as the Khorana score, COMPASS‑CAT, or Vienna‑CATS, with COMPASS‑CAT demonstrating superior predictive accuracy for patients with breast, lung, ovarian, or colon cancer. For high‑risk ambulatory patients, thromboprophylaxis is recommended for up to 6 months, with regular reassessment of risk thereafter. Treatment of CAT favors low‑molecular‑weight heparin or oral direct FXa inhibitors (apixaban, edoxaban, rivaroxaban), with incidental venous thromboembolism managed similarly to symptomatic events. The API‑CAT study supports low‑dose apixaban (2.5 mg twice a day) as a safer long‑term treatment. Screening for antiphospholipid antibodies guides therapeutic strategies. Major challenges for optimization of the antithrombotic treatment include renal impairment, thrombocytopenia, and treatment adherence. Oral direct FXa inhibitors may improve quality of life. Effective CAT management requires individualized care, strong clinician-patient communication, and education. The guideline implementation remains suboptimal. Closing the gap demands national strategies promoting health‑provider training, patient empowerment, e‑health applications, equitable access, and dedicated CAT outpatient clinics for sustained, personalized care.

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来源期刊
CiteScore
4.50
自引率
0.00%
发文量
176
审稿时长
6-12 weeks
期刊介绍: Polish Archives of Internal Medicine is an international, peer-reviewed periodical issued monthly in English as an official journal of the Polish Society of Internal Medicine. The journal is designed to publish articles related to all aspects of internal medicine, both clinical and basic science, provided they have practical implications. Polish Archives of Internal Medicine appears monthly in both print and online versions.
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