预防性抗凝预防低中危血栓风险恶性肿瘤化疗患者血栓形成的疗效

Early anticoagulant intervention in malignant tumor patients receiving chemothrapy at low-moderate thrombus risk

目的 :本研究旨在探讨预防性抗凝治疗在预防低中危血栓风险恶性肿瘤患者血栓形成中的作用。方法 :选择Khorana模型评分≤2分且经静脉多普勒超声检查排除静脉血栓栓塞的146例恶性实体瘤患者,其中接受低分子量肝素预防性抗凝治疗的患者被纳入研究组(57例),未接受预防性抗凝治疗的患者被纳入对照组(89例)。比较2组的抗凝有效率、不良事件发生率、总生存和无进展生存时间。结果 :在83例低危患者中,研究组和对照组的抗凝有效率分别为93.10%和88.89%,差异无统计学意义(P=0.205);在63例中危患者中,研究组和对照组的抗凝有效率分别为85.71%和80.00%,差异亦无统计学无意义(P=0.182)。预防性抗凝治疗相关不良反应主要包括注射部位轻微瘀点、瘀斑和出血。研究组和对照组的总生存和无进展生存均无显著差异(P值均>0.05)。结论 :低中危恶性肿瘤患者可能无须接受预防性抗凝治疗以预防血栓形成。

Objective： To study the clinical significance of early anticoagulant intervention for cancer patients receiving chemotherapy who were in hypercoagulable status.Methods： The 146 patients with malignant solid tumors who were scored≤2 points in Khorana model and confirmed no thrombus by venous Doppler ultrasonography were divided into study group（n = 57） and the control group（n = 89）. The patients in the study group received prophylactic anticoagulant therapy with low-molecular weight heparin（LMWH）. Then the differences in the efficiency of anticoagulation, overall survival（OS） and progression-free survival（PFS） were compared between two groups to analyze the clinical significance of early anticoagulant intervention.Results： The results showed that compared with the control group, the efficiency of anticoagulation in low risk patients（n = 83） increased significantly in the study group（93.10% vs 88.89%, P = 0.205）, and there was the same result in moderate risk patients（n = 63）（85.71% vs 80.00%, P = 0.182）. Major adverse events included mild injection site hemorrhage, petechia and ecchymosis. OS and PFS were not significantly different between the study group and the control group（both P〉0.05）.Conclusion： It is recommended not to give drugs for anticoagulant therapy of hospitalized patients after chemotherapy with malignant solid tumors who are in low or moderate risk.