Sovremennye podkhody k lecheniyui profilaktike tromboticheskikh oslozhneniy v onkologii


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Abstract

Со времен А.Труссо (1865 г.)специалисты уделяют много внимания вопросам свертывания крови у онкологических больных. Этот интерес продиктован, с одной стороны, высокой частотой нарушений системы гемостаза у больных в данной группе, в первую очередь тромботических, а с другой – способностью некоторых активированных факторов коагуляции влиять на прогрессию и метастазирование опухоли. По данным различных исследователей до 4–20% онкологических больных имеют проявления венозного тромбоэмболизма (тромбозы вен и тромбоэмболии легочной артерии. Как следствие венозные тромбозы и тромбоэмболии (ВТЭ) являются одной из лидирующих причин смерти больных с неоплазиями. Высокий риск тромбозов имеют госпитализированные онкологические больные, особенно те, которые получают активную терапию. В популяционных исследованиях диагноз рака повышал риск тромботических осложнений в 4,1 раза, а проведение химиотерапии в 6,5 раза в сравнении с пациентами сходного возраста и факторов риска, не имеющих онкологического диагноза. Среди всех больных, наблюдающихся с тромбозами, каждый пятый (20%) имеет диагноз рака, а каждый восьмой (13%) получает химиотерапию. Учитывая тот факт, что значительная доля венозных тромбозов протекает без клинических проявлений, существует мнение, что частоту этого осложнения недооценивают. Результаты аутопсий свидетельствуют о 50% венозных тромбозов и тромбоэмболий у больных, умерших с онкологическим диагнозом. Более того, в последние годы отмечено увеличение риска тромботических осложнений в этой группе пациентов.

About the authors

V V Ptushkin

ФГУ ФНКЦ ДГОИ Росздрава, Москва

Отдел подростковой и возрастной гематологии и онкологии

References

  1. Trousseau A. Phlegmasia alba dolens. In: Trousseau A, ed. Clinique medicale de l'Hotel- Dieu de Paris. Bailliеre: Paris, 1865; p. 654–712.
  2. Peuscher F.W. Thrombosis and bleeding in cancer patients. Neth J Med 1981; 24: 23–35.
  3. Beer J.H., Haeberli A, Vogt A, Woodtli K et al. Coagulation markers predict survival in cancer patients. Thromb Haemost 2002; 88: 745–9.
  4. Miller G.J., Bauer K.A., Howarth D.J. et al. Increased incidence of neoplasia of the digestive tract in men with persistent activation of the coagulant pathway. J Thromb Haemost 2004; 2: 2107–14.
  5. Khorana A.A., Francis C.W., Culakova E. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5: 632–4.
  6. Heit J.A., Silverstein M.D., Mohr D.N. et al. Risk factors for deep vein thrombosis and pulmonary embolism: A population - based case - control study. Arch Intern Med 2000; 160: 809–15.
  7. Caine G.J., Stonelake P.S., Lip G.Y. et al. The hypercoagulable state of malignancy: Pathogenesis and current debate. Neoplasia 2002; 4: 465–73.
  8. Gomes M.P., Deitcher S.R. Diagnosis of venous thromboembolic disease in cancer patients. Oncology (Huntingt) 2003; 17: 126–35, discussion 139–44.
  9. Stein P.D., Beemath A, Meyers F.A. et al. Incidence of venous thromboembolism in patients hospitalized with cancer. Am J Med 2006; 119: 60–8.
  10. Sorensen H.T., Mellemkjaer L, Olsen J.H. et al. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343: 1846–50.
  11. Elting L.S., Escalante C.P., Cooksley C et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med 2004; 164: 1653–61.
  12. Blom J.W., Doggen C.J., Osanto S et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293: 715–22.
  13. Levitan N, Dowlati A, Remick S.C. et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy: Risk analysis using Medicare claims data. Medicine (Baltimore) 1999; 78: 285–91.
  14. Khorana A.A., Francis C.W., Culakova E et al. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 2006; 24: 484–90.
  15. Cavo M, Zamagni E, Cellini C et al. Deepvein thrombosis in patients with multiple myeloma receiving first - line thalidomide - dexamethasone therapy. Blood 2002; 100: 2272–3.
  16. Decensi A, Maisonneuve P, Rtmensz N et al. Effect of tamoxifen on venous tromboembolic events in a breast cancer prevention. Circulation 2005; 111: 650–6.
  17. Bohlius J, Wilson J, Seidenfeld J et al. Recombinant human erythropoietins and cancer patients: Updated meta - analysis of 57 studies including9353 patients. J Natl Cancer Inst 2006; 98: 708–14.
  18. Barbui T, Finazzi G, Grassi A et al. Thrombosis in cancer patients treated with hematopoietic growth factors - a meta - analysis: On behalf of the Subcommittee on Haemostasis and Malignancy of the Scientific and Standardization Committee of the ISTH. Thromb Haemost 1996; 75: 368–71.
  19. Khorana A.A., Francis C.W., Culakova E et al. Risk factors for chemotherapy - associated venous thromboembolism in a prospective observationalstudy. Cancer 2005; 104: 2822–9.
  20. Abramson N, Costantino J.P., Garber J.E. et al. Effect of Factor V Leiden and prothrombin G20210 - A mutations on thromboembolic risk in the National Surgical Adjuvant Breast and Bowel ASCO Guideline on VTE and Treatment in Patients With Cancer www.jco.org 13 Project Breast Cancer Prevention trial. J Natl Cancer Inst 2006; 98: 904–10.
  21. Geerts W.H., Pineo G.F., Heit J.A. et al. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 338S–400S.
  22. Clarke-Pearson D.L., Synan I.S., Hinshaw W.M. et al. Prevention of postoperative venous thromboembolism by external pneumatic calf compression in patients with gynecologic malignancy. Obstet Gynecol 1984; 63: 92–8.
  23. Roderick P, Nicholson T, Armitage A et al: An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales. Health Technol Assess 2005; 9: 1–178.
  24. Gallus A.S., Hirsh J, O'Brien S.E. et al: Prevention of venous thrombosis with small, subcutaneous doses of heparin. JAMA 1976; 235: 1980–2.
  25. Clagett G.P., Reisch J.S. Prevention of venous thromboembolism in general surgical patients: Results of meta - analysis. Ann Surg 1988; 208: 227–40.
  26. Prevention of fatal postoperative pulmonary embolism by low doses of heparin: An international multicentre trial. Lancet 1975; 2: 45–51.
  27. Bergqvist D, Burmark U.S., Flordal P.A. et al. Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients. Br J Surg 1995; 82: 496–501.
  28. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: A doubleblind randomized multicentre trial with venographic assessment – ENOXACAN Study Group. Br J Surg 1997; 84: 1099–103.
  29. Deitcher S.R. Primary prevention of venous thromboembolic events (VTE) in cancer patients: An American survey study. J Clin Oncol 2004; 22: 750s, (suppl; abstr 8086).
  30. Wille-Jorgensen P, Rasmussen M.S., Andersen B.R. et al. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev 2003; 4: CD001217.
  31. Rasmussen N.S., Jorgensen N.L., Wille-Jorgensen P et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major

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