Conclusion Fraxiparine is safe and effective for treatment of VTE in cancer patients. Patients in early tumor stage at high risk may get more benefits

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峡余磨松
7 years ago
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1 venous thromboembolismvte χ 2 Kaplan-Meier COX 36 60% CR 21 35% PR 3 5% SD D % vs 2. 0% P = III 30 d 5 R R A The efficacy of low molecular weight heparin in sixty cancer patients with venous thromboembolism DU Yong-liang 1 WANG Yan 2 LI Jun-ling 2 PENG Yan 1 MI Yu-ling 1 XI Xiao-ming 1 CHENG Fang 1 WANG Qi 1 ZHANG Xiang-ru 2 1 Sanhuan Cancer Hospital of ChaoyangBeijing China 2 Cancer Hospital Chinese Academy of Medical SciencesBeijing China AbstractObjective To evaluate the efficacy and safety of low molecular weight heparin LMWHFraxiparine in cancer patients with venous thromboembolism VTE. Methods The outcome of fraxiparine treatment in 60 cancer patients with VTE hospitalized from August 2007 to July 2011 were retrospectively analyzed. χ 2 test was used to analyze the correlation between the efficacy incidence of secondly thrombus and clinical factorsand Kaplan-Meier and COX regressive analysis were used to estimate the relationship between clinical factors and prognosis. Results 60% 36 /60 of complete remission CR 35% 21 /60 of partial remission PR and 5% 3 /60 of stable disease SD were observed in fraxiparine treatment by hypodermic injection. No serious complication was found during the treatment. No obvious correlation was discovered between the efficacy of fraxiparine and clinic factors sexualityagehistologystage of tumorsmokewith central venous catheter or notrisk grades period of fraxiparine treatmentchemotherapy agentsquantity of D-D or platelet statistically. The incidence of secondly thrombus was higher in patients with abnormal platelet than in those with normal platelet 33. 3% vs 2. 0% P = In monovariate analysislonger survival was seen in the patients who had early tumor stage I or II who received long period of fraxiparine treatment more than 30 days or who had high risk grades > 5 points. But only the tumor stage and risk grades were independent prognosis factors in multivariate analysis dyl526@ sina. com wangyan@ csco. org. cn

2 Conclusion Fraxiparine is safe and effective for treatment of VTE in cancer patients. Patients in early tumor stage at high risk may get more benefits from anticoagulant treatment. Key wordscancer venous thromboembolism fraxiparine efficacy safety American Society of Clinical Oncology ASCO 1 venous thromboembolism VTE 2 CT 1 4% ~ 20% VTE VTE IU 0. 6 ml VTE 12 h 60 VTE VTE Edward 5. 1% 60 /1 175 VTE Tesselaar VTE 57 VTE Wun 4 VTE VTE 66. 7% 31. 7% 21. 7% 13. 3% 8. 3% VTE 1 60 VTE n % 2012 American College n % CR PR + SD P of Chest Physicians ACCP VTE 3 6 a % % b VTE Ⅲ ~ Ⅳ VTE > % % Ⅰ ~ Ⅱ D

3 1 n % CR PR + SD P NVB % YH d < 30 d % < disease SD progress of diseasepd 7 Caprini 8 VTE 98. 4% VTE Caprini 60 VTE n /% Caprini / ~ > COPD a b D- 0 ~ 0. 3 mg L ~ 300 G L - 1 NVB YH-16 n 0 1 /% / 0 ~ ~ CT 5 SPSS χ 2 Kaplan-Meier COX P < VTE 60% 36 /60 CR 35% 21 /60 J ml PR 5% 3 /60 SD 95% 6150AXaIU IU 0. 6 ml q12h 60 Ⅰ ~ Ⅱ Ⅲ ~ Ⅳ D- 45 d 10 ~ 180 d NVB YH ~ 57 > 30 d < 30 d VTE 4 < 5 5 VTE χ 2 CT 1 complete response CR 2 partial response PR stable 3 VTE Caprini VTE

4 I II III IV 11 P = VTE 5 30 d < 5 < 30 d 20 vs P = vs 10 P = d < 5 40 d P = COX VTE 4 1 Kaplan-Meier 4 COX B SE Wald df Sig. Exp B 95. 0% CI vs I II vs III IV vs < 5 vs vs vs PR + SD vs CR d vs 30 d CR PR SD % 1 20% 13. 3% % 33. 3% vs 2. 0%

5 P = LMWH CR PR + SD < 5 5 NVB YH-16 > 30 d < 30 d D- 30% ~ 40% 5 4 LMWH /% P CR PR + SD D NVB YH d < 30 d < VTE deep vein thrombosis 90% 90% LMWH 95% D- 1 VTE VTE 5 45 d < 5 40 d P = CR < % vs 28. 3% P = < P = ACCP 11 LMWH LDUH ACCP 2012 VTE DVT pulmonary embolism PE VTE d 2 1 VTE > 30 d < 30 d VTE VTE PE 30 d

6 30 d 30 d 1 VTE 6. 7% 4 / % vs 2. 0% P = HR = study J. Lancet Oncol % VTE COX CR 7 VTE J < 30 d patient care J. Dis Mon2005 1LYMAN GHKHORANA AAFALANGA Aet al. American society of clinical oncology guideline recommendations for venous thromboembolism Prophylaxis and Treatment in patients with cancer J. J Clin Oncol HICKS LKCHEUNG MCDING Ket al. Venous thromboembolism and nonsmall cell lung cancer a pooled analysis of National Cancer Institute of Canada Clinical Trials Group trials J. Cancer TESSELAAR MEOSANTO S. Risk of venous thromboembolism in lung cancerj. Curr Opin Pulm Med WUN TWHITE RH. Epidemiology of cancerrelated venous thromboembolismj. Best pract Res Clin Haematol AGNELLI GGUSSONI GBIANCHINI Cet al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy a randomisedplacebo-controlleddouble-blind 6KEARON CAKL EACOMEROTA AJet al. Antithrombotic therapy for VTE disease antithrombotic therapy and prevention of thrombosis 9th ed American College of Chest Physicians Evidence-Based Clinical Practice Guidelines J. Chest Suppl e419s - 94S CAPRINI JA. Thrombosis risk assessment as a guide to quality KIM HKCHOI HHLEE JMet al. Acute renal vein thrombosisoral contraceptivesand protein S deficiency a successful catheter-directed thrombolysis J. Ann Vasc Surg e SNOW VQASEEM ABARRY Pet al. Management of venous thromboembolism a clinical p ractice guideline from the A- merican College of Physicians and the Academy of Family Physicians J. Ann Intern Med KAHN SRLIM WDUNN ASet al. Prevention of VTE in nonsurgical patients antithrombotic therapy and prevention of thrombosis9th ed American College of Chest Physicians Evidence-Based Clinical Practice Guidelines J. Chest Suppl S195 - S J / 櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌櫌 GE KTA TM pure GE KTA TM pure GE KTA TM pure KTA TM UNICORN TM 6 KTA TM pure GE KTA TM KTA TM pure KTA TM pure pure

5-25袁宏钧.indd

5-25袁宏钧.indd 第 24 卷第 5 期 2015 年 5 月碘 131 doi:10.3978/j.issn.1005-6947.2015.05.005 http://dx.doi.org/10.3978/j.issn.1005-6947.2015.05.005 Chinese Journal of General Surgery, 2015, 24(5):643 647. Chinese Journal of