腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件

腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件1目前已經(jīng)證實惡性腫瘤與ⅥTE之間關系密切,惡性腫瘤患者通常處于高狀態(tài),與非惡性腫瘤患者相比,其發(fā)生ⅥTE的風險更高。血栓栓塞事件已經(jīng)成為腫瘤患者的第二大死因。腫瘤患者發(fā)生T通常初始使用低分子肝素(LMMH)進行抗凝臺療,長期抗凝是否可轉換為華法林?亦或更換為新型抗凝藥?目前已經(jīng)證實惡性腫瘤與ⅥTE之間關系密切,惡性腫瘤患者通常處2主要內容腫瘤患者VTE初始治療方案腫瘤患者ⅴTE長期治療肝素VS華法林c帥患7長0GN法林總結主要內容3參考文獻1.HighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-BasedChemotherapyLargeRetrospectiveAnalysis[]JClinOncol.2019,29(25):34662.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J].Cancer.2019,1193):648-55.3.Anticoagulationforthelong-termtreatmentofvenousthromboembolisminpatientswithcancer[ICochraneDatabaseSystRev,2019,8(74.OralrivaroxabanversusstandardtherapyforthetreatmentofsymvenousthromboembolismapooledanalysisoftheEINSTEIN-DVTandPErandomizedstudies[J].ThrombJ2019:11:215.DirectoralanticoagulantsinpatientswithVTEandcancer:asystematicreviewandmeta-analysis[]Chest.2019:147(2475-4846.Prosandconsofneworalanticoagulantsinthetreatmentofvenousthromboembolisminpatientsithcancer[J].InterEmergMed.2019,10(6):651-656.參考文獻4流行病學Table2.OverallIncidenceofThromboembolicEvents(Nm932)No.ofThromboembolicEventThrombosisTypesofthromboses(nm169DVTalone433497PEalone254DVT+PEArterialthrombosisalone83DVTarterialthrombosis30TyetoTEE(days)Fig1.Tininpstientswhodevelpedathrembcemacleven:TEEHighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-BasedChemotherapy:A流行病學5流行病學■ACaoerpert1734口ortoWa1728ORTOnFigure2.Incdenceofveneusthromboembolism(VTEisillustratedforthecancerandnoncancercohorts.Anasteriskindicates<0001,DVTincicatesdeepveinthrombosis:PEFigure3.TheIncidenceofvenousthrompoemboismisilluspulmonaryembolism.ratedaccordingtocancertype.2.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J]cancer.:2019,193648-5流行病學6「腫癌患者VT治療方案選擇2019ASC021IESMOclinicalpracticequideines73m262w112Wwwz?OURNALOFCLINICALONCOLOGYA5COSPECIALARTICLEManagementofvenousthromboembolism(TE)incancerpatients:ESMOClinicalPracticeGuidelinesVenousThromboembolismProphylaxisandTreatOncologyClinicalPracticeGuidelineUpdate2019IEsrt-hmcves1IECHESTAntithromboticTherapyforVTEDiseaseomunCHESTGuidelineandExpertPanelReportCancer-AssociatedMm的共然柳D幽做的唱烈mVenousThromboembolicDisease線心心戰(zhàn)心三心2019ACCP2019NCCN「腫癌患者VT治療方案選擇72019EMSO2019ASCO2019CNNC2019ACCPaltreatmeLMWHisrecommendedLMWH,UFHfortheinitial5to10daysLMWHovervKaCrcl<25-30mL,UFHoftreatmentofVteasLMWH,UFHorFXaorlmwhwithantiwellasforlong-termantagonistsaccordingtoisrecommendeclinicalsituationdoxaban(2C)atfirst3monthsLongtermtreatmentextendedanticoagulanttherapy(noscheduledstopUseofnoveloralLMWHispreferred.date)over3monthsof75%0-80%coftheinitiadosefor6monthsofIndefiniteerapy(IB),orhaveacurrentlyrecommendedLMWHissafeandmoreforpatientswithanticoagulationinhighbleedingrisk,gestextendedeffectivethanVKA.(1,A)malignancyandVTEcancerorpersistentriskanticoagulanttherapy(nofactorsscheduledstopdate)over3monthsoftherapy(2B)2019EMSO8「腫瘤患者VTE指南推薦治療方案總結腫瘤患者發(fā)生VTE時起始治療各指南均推薦LMWH。長期治療藥物選擇方面除ASCO指南說明無法使用LMWH時可選擇VKA,其余均說明LMWH優(yōu)于VKA?；顒有阅[瘤或血栓誘因持續(xù)存在時,療程不確定,長期抗凝優(yōu)于短期抗凝(3個月)?！改[瘤患者VTE指南推薦治療方案總結9腫瘤患者VTE長期治療LMWHVS華法林0,033recordsidentifiedthrough55additionalrecordidentifiedthroughdatabasesearchingothersources9559recordsafterduplicatesremoved54full-textarticlesexcluded,withreasons4-unavailabledataforcancersubgroup:1=case9559recordsscreenedseries:15=review4=retrospectivetudy:2=protocol:6=observationstudy:4=nonrandomizedtrial:4=nocancer65full-textarticlesassessedforeligibilitypatientsincluded:1=onlyonecancerpatientincluded:2-norelevantoutcome1=differentdurationsofintervention10studiesincludedinqualitativesynthesis(11reports)10studiesincludedinqualitativesynthesis(meta-analysis)3.Anticoagulationforthelong-termtreatmentofvenousthromboembolisminpatientswithcancer.CochraneDatabaseSystRev,20198(7腫瘤患者VTE長期治療LMWHVS華法林10腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件11腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件12腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件13腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件14腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件15腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件16腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件17腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件18腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件19腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件20腫瘤患者靜脈血栓栓塞的抗凝治療與管理課件