肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件

肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件1目前已经证实恶性肿瘤与ⅥTE之间关系密切,恶性肿瘤患者通常处于高状态,与非恶性肿瘤患者相比,其发生ⅥTE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T通常初始使用低分子肝素(LMMH)进行抗凝台疗,长期抗凝是否可转换为华法林?亦或更换为新型抗凝药?目前已经证实恶性肿瘤与ⅥTE之间关系密切,恶性肿瘤患者通常处2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c帅患7长0GN法林总结主要内容3参考文献1.HighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-BasedChemotherapyLargeRetrospectiveAnalysis[]JClinOncol.2019,29(25):34662.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J].Cancer.2019,1193):648-55.3.Anticoagulationforthelong-termtreatmentofvenousthromboembolisminpatientswithcancer[ICochraneDatabaseSystRev,2019,8(74.OralrivaroxabanversusstandardtherapyforthetreatmentofsymvenousthromboembolismapooledanalysisoftheEINSTEIN-DVTandPErandomizedstudies[J].ThrombJ2019:11:215.DirectoralanticoagulantsinpatientswithVTEandcancer:asystematicreviewandmeta-analysis[]Chest.2019:147(2475-4846.Prosandconsofneworalanticoagulantsinthetreatmentofvenousthromboembolisminpatientsithcancer[J].InterEmergMed.2019,10(6):651-656.参考文献4流行病学Table2.OverallIncidenceofThromboembolicEvents(Nm932)No.ofThromboembolicEventThrombosisTypesofthromboses(nm169DVTalone433497PEalone254DVT+PEArterialthrombosisalone83DVTarterialthrombosis30TyetoTEE(days)Fig1.Tininpstientswhodevelpedathrembcemacleven:TEEHighIncidenceofThromboembolicEventsinPatientsTreatedWithCisplatin-BasedChemotherapy:A流行病学5流行病学■ACaoerpert1734口ortoWa1728ORTOnFigure2.Incdenceofveneusthromboembolism(VTEisillustratedforthecancerandnoncancercohorts.Anasteriskindicates<0001,DVTincicatesdeepveinthrombosis:PEFigure3.TheIncidenceofvenousthrompoemboismisilluspulmonaryembolism.ratedaccordingtocancertype.2.Venousthromboembolisminthecanceroutpatientsetting:contemporaryratesandpredictorsintheUnitedStates[J]cancer.:2019,193648-5流行病学6「肿癌患者VT治疗方案选择2019ASC021IESMOclinicalpracticequideines73m262w112Wwwz?OURNALOFCLINICALONCOLOGYA5COSPECIALARTICLEManagementofvenousthromboembolism(TE)incancerpatients:ESMOClinicalPracticeGuidelinesVenousThromboembolismProphylaxisandTreatOncologyClinicalPracticeGuidelineUpdate2019IEsrt-hmcves1IECHESTAntithromboticTherapyforVTEDiseaseomunCHESTGuidelineandExpertPanelReportCancer-AssociatedMm的共然柳D幽做的唱烈mVenousThromboembolicDisease线心心战心三心2019ACCP2019NCCN「肿癌患者VT治疗方案选择72019EMSO2019ASCO2019CNNC2019ACCPaltreatmeLMWHisrecommendedLMWH,UFHfortheinitial5to10daysLMWHovervKaCrcl<25-30mL,UFHoftreatmentofVteasLMWH,UFHorFXaorlmwhwithantiwellasforlong-termantagonistsaccordingtoisrecommendeclinicalsituationdoxaban(2C)atfirst3monthsLongtermtreatmentextendedanticoagulanttherapy(noscheduledstopUseofnoveloralLMWHispreferred.date)over3monthsof75%0-80%coftheinitiadosefor6monthsofIndefiniteerapy(IB),orhaveacurrentlyrecommendedLMWHissafeandmoreforpatientswithanticoagulationinhighbleedingrisk,gestextendedeffectivethanVKA.(1,A)malignancyandVTEcancerorpersistentriskanticoagulanttherapy(nofactorsscheduledstopdate)over3monthsoftherapy(2B)2019EMSO8「肿瘤患者VTE指南推荐治疗方案总结肿瘤患者发生VTE时起始治疗各指南均推荐LMWH。长期治疗药物选择方面除ASCO指南说明无法使用LMWH时可选择VKA,其余均说明LMWH优于VKA。活动性肿瘤或血栓诱因持续存在时,疗程不确定,长期抗凝优于短期抗凝(3个月)。「肿瘤患者VTE指南推荐治疗方案总结9肿瘤患者VTE长期治疗LMWHVS华法林0,033recordsidentifiedthrough55additionalrecordidentifiedthroughdatabasesearchingothersources9559recordsafterduplicatesremoved54full-textarticlesexcluded,withreasons4-unavailabledataforcancersubgroup:1=case9559recordsscreenedseries:15=review4=retrospectivetudy:2=protocol:6=observationstudy:4=nonrandomizedtrial:4=nocancer65full-textarticlesassessedforeligibilitypatientsincluded:1=onlyonecancerpatientincluded:2-norelevantoutcome1=differentdurationsofintervention10studiesincludedinqualitativesynthesis(11reports)10studiesincludedinqualitativesynthesis(meta-analysis)3.Anticoagulationforthelong-termtreatmentofvenousthromboembolisminpatientswithcancer.CochraneDatabaseSystRev,20198(7肿瘤患者VTE长期治疗LMWHVS华法林10肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件11肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件12肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件13肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件14肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件15肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件16肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件17肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件18肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件19肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件20肿瘤患者静脉血栓栓塞的抗凝治疗与管理课件