将癌症相关静脉血栓栓塞治疗从连续LMWH转换为DOACs:一个评估
Wei Kang1,2, Chin-Yao Shen3,4, Michael Chun-Yuan Cheng3,4
1School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
Thrombosis and haemostasis
|January 30, 2026
概括
将癌症患者从低分子量肝素 (LMWH) 转换为直接口服抗凝剂 (DOAC) 是安全有效的. 这种过渡没有显示VTE或出血风险增加,死亡风险较低.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
背景情况:
- 直接口服抗凝剂 (DOAC) 越来越多地用于与癌症相关的血栓形成 (CT).
- 在CT患者中从低分子量肝素 (LMWH) 转换为DOAC的安全性和有效性尚未得到充分证实.
- 目前的治疗指南要求进一步证实这种过渡.
研究的目的:
- 在CT患者中,评估从LMWH切换到DOAC的安全性和有效性.
- 为了比较转换者和持续LMWH用户之间复发性静脉血栓栓塞 (VTE),严重出血和全因死亡率的风险.
- 为CT的抗凝管理提供基于证据的建议.
主要方法:
- 在台湾 (2013-2021年) 使用链接索赔和注册表数据库进行全境队列研究.
- 包括3,885名CT患者,最初接受LMWH治疗.
- 使用考克斯回归和细灰模型进行分析,对治疗权重的反向概率.
主要成果:
- 在3885名患者中,59.5%的患者转向了DOAC.
- 与连续的LMWH相比,切换到DOACs在复发性VTE (HR:0.86) 或严重出血 (HR:0.89) 中没有显著差异.
- 切换到DOAC与所有原因死亡率的风险明显降低相关 (HR:0.67).
结论:
- 切换到DOAC是CT患者连续LMWH的安全有效替代方案.
- 这一发现无论LMWH的初始持续时间,整体治疗持续时间或患者的脆弱性如何,都是如此.
- 在癌症相关的血栓形成中,DOACs代表了抗凝管理的可行选择.
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