肿瘤患者静脉血栓栓塞的抗凝治疗与管理ppt课件

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1、肿瘤相关VTE治疗研究进展前言目前已经证实恶性肿瘤与VTE之间关系密切，恶性肿瘤患者通常处于高凝状态，与非恶性肿瘤患者相比，其发生VTE的风险更高。血栓栓塞事件已经成为肿瘤患者的第二大死因。肿瘤患者发生VTE通常初始使用低分子肝素（LMWH）进行抗凝治疗，长期抗凝是否可转换为华法林？亦或更换为新型抗凝药？04020103主要内容肿瘤患者VTE初始治疗方案肿瘤患者VTE长期治疗肝素VS华法林肿瘤患者VTE长期治疗DOACsVS华法林总结参考文献1.HighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-B

2、asedChemotherapy:ALargeRetrospectiveAnalysis[J].JClinOncol.2011,29(25):3466-73.2.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J].Cancer.2013,119(3):648-55.3.Anticoagulationforthelong-termtreatmentofvenousthromboembolisminpatientswithcancer

3、[J].CochraneDatabaseSystRev,2014,8(7).4.Oralrivaroxabanversusstandardtherapyforthetreatmentofsymptomaticvenousthromboembolism:apooledanalysisoftheEINSTEIN-DVTandPErandomizedstudies[J].ThrombJ2013;11:21.5.DirectoralanticoagulantsinpatientswithVTEandcancer:asystematicreviewandmeta-analysis[J].

4、Chest.2015;147(2):475-484.6.Prosandconsofneworalanticoagulantsinthetreatmentofvenousthromboembolisminpatientswithcancer[J].InterEmergMed.2015,10(6):651-656.流行病学1.HighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-BasedChemotherapy:ALargeRetrospectiveAnalysis[J].JClinOncol.2011

5、,29(25):3466-3473.流行病学2.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J].Cancer.2013,119(3):648-55.肿瘤患者VTE治疗方案选择2014ASCO211ESMO2016ACCP2016NCCN肿瘤患者VTE治疗方案选择2011EMSO2014ASCO2016CNNC2016ACCPInitialtreatmentLMWH，UFH.Crcl<25–30ml,UFHorLMWHwitha

6、nti-Xaactivitymonitoringisrecommended[I,A]LMWHisrecommendedfortheinitial5to10daysoftreatmentofVTEaswellasforlong-termsecondaryprophylaxisforatleast6months.LMWH,UFHorFXaantagonistsaccordingtopatient’scharacteristicsandclinicalsituation.LMWHoverVKAtherapydabigatran,rivar-oxaban,apixabanoredoxa

7、ban(2C)atfirst3months.Longtermtreatment75%-80%oftheinitialdosefor6monthsofLMWHissafeandmoreeffectivethanVKA.(I,A)UseofnoveloralanticoagulantsisnotcurrentlyrecommendedforpatientswithmalignancyandVTE.LMWHispreferred.Indefiniteanticoagulationinpatient