60 1 2 2 1 1 1 1 1 2 1 100122 2 100021 venous thromboembolismvte 2007 8-2011 7 60 χ 2 Kaplan-Meier COX 36 60% CR 21 35% PR 3 5% SD D- 33. 3% vs 2. 0% P = 0. 009 III 30 d 5 R979. 1 R969. 4 A 1003-3734 2012 18-2183 - 06 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 100122China 2 Cancer Hospital Chinese Academy of Medical SciencesBeijing 100121China 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 = 0. 009. 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. 010 67475557-220 E-mail dyl526@ sina. com 010 87787471 E-mail wangyan@ csco. org. cn 2183 2012 21 18
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 3 6 150 IU 0. 6 ml VTE 12 h 60 VTE VTE Edward 5. 1% 60 /1 175 VTE 2 10 7 6 Tesselaar 3 3 6 VTE 57 VTE Wun 4 VTE VTE 66. 7% 31. 7% 21. 7% 13. 3% 8. 3% 3 5 1 VTE 1 60 VTE n % 2012 American College n % CR PR + SD P of Chest Physicians ACCP 60 39 65. 0 22 56. 4 17 43. 6 0. 582 VTE 3 6 a 22 36. 7 13 59. 1% 9 40. 9% b 55 91. 7 32 58. 2 23 41. 8 VTE Ⅲ ~ Ⅳ 42 70. 0 24 57. 1 18 42. 9 2007 8-2011 7 VTE 60 1 2007 8-2011 7 2184 2012 21 18 1 175 > 60 21 35. 0 14 66. 7 7 33. 3 38 63. 3 23 60. 5% 15 39. 5% 1. 000 5 8. 3 4 80. 0 1 20. 0 0. 639 Ⅰ ~ Ⅱ 18 30. 0 12 66. 7 6 33. 3 0. 573 51 85. 0 30 58. 9 21 41. 1 0. 729 9 15. 0 6 66. 7 3 33. 3 D- 44 73. 3 25 56. 8 19 43. 2 0. 554 16 26. 7 11 68. 8 5 31. 2 2 34 56. 7 23 67. 6 11 32. 4 0. 193 1 26 43. 3 13 50. 0 13 50. 0 29 48. 3 18 62. 1 11 37. 9 0. 797 31 51. 7 18 58. 1 13 41. 9
1 n % CR PR + SD P 43 71. 7 28 65. 1 15 34. 9 0. 248 17 28. 3 8 47. 1 9 52. 9 NVB 19 31. 7% 12 63. 2 7 36. 8 0. 784 41 68. 3 24 58. 5 17 41. 5 YH-16 5 8. 3 4 80. 0 1 20. 0 0. 639 55 91. 7 32 58. 2 23 41. 8 30 d 46 76. 7 26 56. 5 20 43. 5 0. 368 < 30 d 14 23. 3% 10 71. 4 4 28. 6 5 43 71. 7 29 67. 4 14 32. 6 0. 082 < 5 17 28. 3 7 41. 1 10 58. 9 disease SD progress of diseasepd 7 Caprini 8 VTE 98. 4% VTE 2 3 2 Caprini 60 VTE n /% Caprini / 60 100 2 43 71. 7 2 40 ~ 60 38 63. 3 1 > 60 21 35 2 COPD 3 5 1 a 6 3 3 2 1 b 24 20 9 2 D- 0 ~ 0. 3 mg L - 1 100 ~ 300 G L - 1 NVB YH-16 n 0 1 /% 0 1. 6 / 0 ~ 1 2 16 26. 7 3 ~ 4 2 1 CT 5 SPSS 17. 0 χ 2 Kaplan-Meier COX P < 0. 05 3 VTE 60% 36 /60 CR 35% 21 /60 J20090004 0. 6 ml PR 5% 3 /60 SD 95% 6150AXaIU 6 150 IU 0. 6 ml q12h 60 Ⅰ ~ Ⅱ Ⅲ ~ Ⅳ D- 45 d 10 ~ 180 d NVB YH-16 37 3 ~ 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 43 71. 7 5 1 20 VTE 2185 2012 21 18
I II III IV 11 P = 0. 012 1 VTE 5 30 d < 5 < 30 d 20 vs 10. 7 P = 0. 002 vs 10 P = 0. 029 2 3 5 45 d < 5 40 d P = 1. 00 COX VTE 4 1 Kaplan-Meier 4 COX B SE Wald df Sig. Exp B 95. 0% CI vs 0. 251 0. 408 0. 378 1 0. 539 1. 285 0. 578 2. 859 I II vs III IV - 1. 072 0. 546 3. 859 1 0. 049 0. 342 0. 118 0. 998 vs - 0. 804 0. 719 1. 251 1 0. 263 0. 447 0. 109 1. 832 < 5 vs 5 1. 074 0. 442 5. 908 1 0. 015 2. 926 1. 231 6. 953 vs - 1. 100 0. 664 2. 741 1 0. 098 0. 333 0. 091 1. 224 vs - 0. 154 0. 399 0. 150 1 0. 698 0. 857 0. 392 1. 872 0. 015 0. 020 0. 579 1 0. 447 1. 015 0. 976 1. 056 PR + SD vs CR - 0. 318 0. 434 0. 539 1 0. 463 0. 727 0. 311 1. 702 30 d vs 30 d 0. 699 0. 454 2. 375 1 0. 123 2. 012 0. 827 4. 897 CR PR SD 3 3. 3% 1 20% 13. 3% 1 4 6. 7% 33. 3% vs 2. 0% 2186 2012 21 18 60 2
P = 0. 009 LMWH CR PR + SD < 5 5 NVB YH-16 > 30 d < 30 d D- 30% ~ 40% 5 4 LMWH 7 9-5 10 /% P CR 3 8. 3 0. 643 PR + SD 1 4. 2 1 2. 0 0. 009 3 33. 3 D- 2 4. 5 0. 287 2 12. 5 3 7. 0 1. 000 NVB 1 5. 9 0 0. 0 0. 297 YH-16 4 9. 8 0 0. 0 1. 000 4 7. 3 30 d 3 6. 5 1. 000 < 30 d 1 7. 1 5 3 7. 0 1. 000 < 5 1 5. 9 VTE deep vein thrombosis 90% 90% LMWH 95% D- 1 VTE VTE 5 45 d < 5 40 d P = 1. 00 5 CR < 5 71. 7% vs 28. 3% P = 0. 082 < 5 10. 7 P = 0. 002 2012 ACCP 11 LMWH LDUH ACCP 2012 VTE DVT pulmonary embolism PE VTE 3 3 1 3 3 45 d 2 1 VTE > 30 d < 30 d VTE VTE PE 30 d 2187 2012 21 18
30 d 30 d 1 VTE 6. 7% 4 /60 12 33. 3% vs 2. 0% P = 0. 009 HR = study J. Lancet Oncol 200910 10 943-949. 0. 33 95% 0. 091 1. 224 VTE COX 2188 2012 21 18 CR 7 VTE J. 2011 31 10 < 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 Oncol2007 25 34 5490-5505. 2HICKS 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 2009115 23 5516-5525. 3TESSELAAR MEOSANTO S. Risk of venous thromboembolism in lung cancerj. Curr Opin Pulm Med200713 5 362-367. 4WUN TWHITE RH. Epidemiology of cancerrelated venous thromboembolismj. Best pract Res Clin Haematol 2009 22 1 9-23. 5AGNELLI 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. Chest2012 141 2 Suppl e419s - 94S.. 89 911-917. 8CAPRINI JA. Thrombosis risk assessment as a guide to quality 51 2-3 70-78. 9KIM HKCHOI HHLEE JMet al. Acute renal vein thrombosisoral contraceptivesand protein S deficiency a successful catheter-directed thrombolysis J. Ann Vasc Surg 2009 23 5 687. e1-4. 10SNOW 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 Med20075 1 74-80. 11KAHN 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. Chest2012141 2 Suppl S195 - S226. 12. J. 200818 3 372-374. / 2012-08 - 09 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 2012 8 24 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