Öz
Abstract
Venous thromboembolism (VTE) is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8%in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH) or low molecular weight heparin (LMWH). Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.
Keywords: Venous thromboembolism, cancer, anticoagulation, chemotherapy, low molecular weight heparin
Özet
Venöz tromboembolizm (VTE) kanser hastalığının major komplikasyonu, morbidite ve mortalitenin en önemli nedenidir. Kanser hastalarında VTE insidansı %0,6-7,8 olup, kanser olmayan hastalardaki VTE insidansından 2 kat daha fazladır. Kanser hastalarında VTE görülme riski, buna derin ven trombozu ve pulmoner embolism de eklendiğinde 2-7 kat arası artmaktadır. VTE riski özellikle hastanede yatan kanser hastalarında ve antineoplastik tedavi alanlarda yüksektir. Bununla beraber büyük cerrahi operasyon geçiren hastalarda da VTE riski artmaktadır. Travma, uzun sureli yolculuk, ileri yaş, obezite, önceden geçirilmiş VTE ve genetik gibi faktörler VTE için predispozan faktörlerdendir. Kanser hastalarındaki tromboproflaksideki primer amaç VTE gelişmesini önlemektir. Kanser hastalarının büyük bir çoğunluğu fraksiyone olmayan heparin ve düşük molekül ağırlıklı heparin ile tedavi edilmelidir. Büyük cerrahi operasyon geçiren kanser hastalarında proflaksi yapılmalıdır.
Anahtar sözcükler: Venöz tromboembolizm, kanser, antikoagulasyon, kemoterapi, düşük molekül ağırlıklı heparinAnahtar Kelimeler
Venous thromboembolism cancer anticoagulation chemotherapy low molecular weight heparin
Kaynakça
- Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, Melton LJ 3rd. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007; 110: 2339-46.
- Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166: 458-64.
- Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293: 715-22.
- Chew HK, Wun T, Harvey DJ, Zhou H, White RH. Incidence of venous thromboembolism and the impact on survival in breast cancer patients. J Clin Oncol 2007; 25: 70-6.
- Bick RL. Cancer-associated thrombosis: focus on extended therapy with dalteparin. J Support Oncol 2006; 4: 115-20.
- Sİrensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Eng J Med 2000; 343: 1846-50. Blanco-Molina A, Trujillo-Santos J, Tirado R, Canas I, Riera A, Valdes M, Monreal M; RIETE Investigators. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb haemost 2009; 101: 478-82.
- Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med 2004; 164: 1965-76.
- Nalluri SR, Chu D, Keresztes R, Zhu X, Wu S. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA 2008; 300: 2277-85.
- Kilickap S, Abali H, Celik I. Bevacizumab, bleeding, thrombosis, and warfarin. J Clin Oncol 2003; 21: 3542.
- Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B, Harousseau J, Zonder JA, Cavo M, Zangari M, Attal M, Belch A, Knop S, Joshua D, Sezer O, Ludwig H, Vesole D, Bladé J, Kyle R, Westin J, Weber D, Bringhen S, Niesvizky R, Waage A, von Lilienfeld-Toal M, Lonial S, Morgan GJ, Orlowski RZ, Shimizu K, Anderson KC, Boccadoro M, Durie BG, Sonneveld P, Hussein MA; International Myeloma Working Group. Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 2008; 22: 414-23.
- Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21: 3665-75.
- Mihmanli I, Cantaşdemir M, Kantarcı F, Mandel NM, Çokyüksel O. Lowerextremity deep venous thrombosis after upper-extremity port catheter placement: an unusual complication. J Clin Ultrasound 2002; 30: 562-5.
- Moheimani F, Jackson DE. Venous thromboembolism: classification, risk factors, diagnosis, and management. ISRN Hematol 2011; 2011:124610.
- Van Langevelde K, Tan M, Srámek A, Huisman MV, de Roos A. Magnetic resonance imaging and computed tomography developments in imaging of venous thromboembolism. J Magn Reson Imaging 2010; 32:1302-12.
- Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 1988; 208: 227-40.
- Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI; American College of Chest Physicians. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 141-59.
- Prandoni P. How I treat venous thromboembolism in patients with cancer. Blood 2005; 106: 4027-33.
- Wells PS, Anderson DR, Rodger MA, Forgie MA, Florack P, Touchie D, Morrow B, Gray L, O'Rourke K, Wells G, Kovacs J, Kovacs MJ. A randomized trial comparing 2 low-molecular-weight heparins for the outpatient treatment of deep vein thrombosis and pulmonary embolism. Arch Intern Med 2005 Apr 11; 165: 733-8.
- Doğan OT, Polat ZA, Karahan O, Epöztürk K, Altun A, Akkurt İ, Çetin A. Antiangiogenic activities of bemiparin sodium, enoxaparin sodium, nadroparin calcium and tinzaparin sodium. Thromb Res 2011; 128: e29-32.
- Carson W, Schilling B, Simons WR, Parks C, Choe Y, Faria C, Powers A. Comparative Effectiveness of Dalteparin and Enoxaparin in a Hospital Setting. J Pharm Pract 2012; 25:180-9.
- Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F; ENOXACAN II Investigators. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-80.
- Lim W, Dentali F, Eikelboom JW, Crowther MA. Meta-analysis: low-molecularweight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med 2006; 144: 673-84.
Öz
Venöz tromboembolizm (VTE) kanser hastalığının major komplikasyonu, morbidite ve mortalitenin en önemli nedenidir. Kanser hastalarında VTE insidansı %0,6-7,8 olup, kanser olmayan hastalardaki VTE insidansından 2 kat daha fazladır. Kanser hastalarında VTE görülme riski, buna derin ven trombozu ve pulmoner embolism de eklendiğinde 2-7 kat arası artmaktadır. VTE riski özellikle hastanede yatan kanser hastalarında ve antineoplastik tedavi alanlarda yüksektir. Bununla beraber büyük cerrahi operasyon geçiren hastalarda da VTE riski artmaktadır. Travma, uzun sureli yolculuk, ileri yaş, obezite, önceden geçirilmiş VTE ve genetik gibi faktörler VTE için predispozan faktörlerdendir. Kanser hastalarındaki tromboproflaksideki primer amaç VTE gelişmesini önlemektir. Kanser hastalarının büyük bir çoğunluğu fraksiyone olmayan heparin ve düşük molekül ağırlıklı heparin ile tedavi edilmelidir. Büyük cerrahi operasyon geçiren kanser hastalarında proflaksi yapılmalıdır.
Anahtar Kelimeler
Venöz tromboembolizm kanser antikoagulasyon kemoterapi düşük molekül ağırlıklı heparin
Kaynakça
- Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, Melton LJ 3rd. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 2007; 110: 2339-46.
- Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166: 458-64.
- Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293: 715-22.
- Chew HK, Wun T, Harvey DJ, Zhou H, White RH. Incidence of venous thromboembolism and the impact on survival in breast cancer patients. J Clin Oncol 2007; 25: 70-6.
- Bick RL. Cancer-associated thrombosis: focus on extended therapy with dalteparin. J Support Oncol 2006; 4: 115-20.
- Sİrensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Eng J Med 2000; 343: 1846-50. Blanco-Molina A, Trujillo-Santos J, Tirado R, Canas I, Riera A, Valdes M, Monreal M; RIETE Investigators. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb haemost 2009; 101: 478-82.
- Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med 2004; 164: 1965-76.
- Nalluri SR, Chu D, Keresztes R, Zhu X, Wu S. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA 2008; 300: 2277-85.
- Kilickap S, Abali H, Celik I. Bevacizumab, bleeding, thrombosis, and warfarin. J Clin Oncol 2003; 21: 3542.
- Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B, Harousseau J, Zonder JA, Cavo M, Zangari M, Attal M, Belch A, Knop S, Joshua D, Sezer O, Ludwig H, Vesole D, Bladé J, Kyle R, Westin J, Weber D, Bringhen S, Niesvizky R, Waage A, von Lilienfeld-Toal M, Lonial S, Morgan GJ, Orlowski RZ, Shimizu K, Anderson KC, Boccadoro M, Durie BG, Sonneveld P, Hussein MA; International Myeloma Working Group. Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia 2008; 22: 414-23.
- Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21: 3665-75.
- Mihmanli I, Cantaşdemir M, Kantarcı F, Mandel NM, Çokyüksel O. Lowerextremity deep venous thrombosis after upper-extremity port catheter placement: an unusual complication. J Clin Ultrasound 2002; 30: 562-5.
- Moheimani F, Jackson DE. Venous thromboembolism: classification, risk factors, diagnosis, and management. ISRN Hematol 2011; 2011:124610.
- Van Langevelde K, Tan M, Srámek A, Huisman MV, de Roos A. Magnetic resonance imaging and computed tomography developments in imaging of venous thromboembolism. J Magn Reson Imaging 2010; 32:1302-12.
- Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 1988; 208: 227-40.
- Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI; American College of Chest Physicians. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 141-59.
- Prandoni P. How I treat venous thromboembolism in patients with cancer. Blood 2005; 106: 4027-33.
- Wells PS, Anderson DR, Rodger MA, Forgie MA, Florack P, Touchie D, Morrow B, Gray L, O'Rourke K, Wells G, Kovacs J, Kovacs MJ. A randomized trial comparing 2 low-molecular-weight heparins for the outpatient treatment of deep vein thrombosis and pulmonary embolism. Arch Intern Med 2005 Apr 11; 165: 733-8.
- Doğan OT, Polat ZA, Karahan O, Epöztürk K, Altun A, Akkurt İ, Çetin A. Antiangiogenic activities of bemiparin sodium, enoxaparin sodium, nadroparin calcium and tinzaparin sodium. Thromb Res 2011; 128: e29-32.
- Carson W, Schilling B, Simons WR, Parks C, Choe Y, Faria C, Powers A. Comparative Effectiveness of Dalteparin and Enoxaparin in a Hospital Setting. J Pharm Pract 2012; 25:180-9.
- Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F; ENOXACAN II Investigators. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-80.
- Lim W, Dentali F, Eikelboom JW, Crowther MA. Meta-analysis: low-molecularweight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med 2006; 144: 673-84.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Derlemeler |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Eylül 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |