肿瘤相关静脉血栓栓塞症中新型口服抗凝药应用进展

Role and challenge of new oral anticoagulants in the treatment of cancer-associated venous thromboembolism

目的回顾NOACs在治疗CAVTE中的特点、疗效、不良反应及相关进展,并讨论其在CAVTE中面临的挑战及前景。方法应用PubMed、CNKI、万方数据库和维普中文科技期刊数据库检索系统,以"new oral anticoagulants、cancer-associated venous thromboembolism、low molecular weight heparin"及"新型口服抗凝药、肿瘤相关静脉血栓、低分子肝素"为关键词,检索2009-10-2019-10的相关文献。纳入标准:(1)NOACs;(2)CAVTE;(3)NOACs治疗CAVTE的病例对照研究。根据纳入标准分析文献44篇,其中中文4篇,英文40篇。结果NOACs在治疗肿瘤相关静脉血栓中的疗效不低于传统治疗药物,VTE复发风险低于低分子肝素,在非消化道肿瘤中其主要出血不良反应可耐受,患者依从性较好。但肿瘤患者存在特殊性,CAVTE应用NOACs的抗凝与出血风险评估、抗凝疗程周期、抗凝剂量、不良反应监测和相互作用等方面都面临挑战,均需充分权衡利弊,进行个体化抗凝管理。结论NOACs在CAVTE中的治疗越来越受到关注,应用日益广泛。但NOACs也面临一些挑战,CAVTE应用NOACs的获益需要更多的研究数据支持,而血栓与出血风险的权衡需要大量基于临床经验的个体化治疗。

Objective To review the characteristics,efficacy,adverse drug reactions,and recent advances of NOACs as traditional drugs in the treatment of CAVTE.The challenges and prospects were discussed.Methods It’s retrieved in PubMed,CNKI,and Wanfang database from Oct 2009 to Oct 2019 using terms"new oral anticoagulants,cancer-associated venous thromboembolism,low molecular weight heparin"as keywords.Inclusion criteria:(1)NOACs;(2)CAVTE;(3)Case-control study of NOACs in CAVTE.According to the inclusion criteria,a total of 44 studies(4 in Chinese and40 in English)were included in the analysis.Results The efficacy of NOACs in the treatment of CAVTE was not inferior to the traditional treatment drugs,VTE recurrence risk was lower than low molecular weight heparin.In patients without digestive cancer,the main adverse bleeding reactions were tolerable and indicating good compliance.However,CAVTE exhibits the characteristics of itself,there were challenges including that anticoagulation and bleeding risk assessment,anticoagulation course,anticoagulant dosage,adverse reaction monitoring,and drug-drug interaction in the application of NOACs.All pros and cons needed to be fully weighed for individualized anticoagulation management.Conclusions NOACs are increasingly widely used in the treatment of CAVTE and attracting more attention.In recent years,as researches go deeper,NOACs are also facing some challenges.The benefits of NOACs in CAVTE need more research data to support,and the balance between thrombosis and bleeding risk requires a lot of individualized treatment based on clinical experiences.