直接口服抗凝血劑在癌症相關靜脈血栓栓塞治療的角色

Therapeutic Role of Direct Oral Anticoagulants on Cancer-Associated Venous Thromboembolism Treatment

張美惠(Mei-Hui Chang) ； 林鴻銓(Horng-Chyuan Lin) ； 蔡慈貞(Tzu-Cheng Tsai)

《腫瘤護理雜誌》 17卷2期 (2017/12) Pp. 37-45

https://doi.org/10.3966/168395442017121702004

摘要

靜脈血栓栓塞是癌症病人常見併發症，而且具有高復發風險及出血率，導致死亡率及整體醫療支出增加。綜合各國治療準則，急性期建議先使用低分子量肝素，接著3-6個月繼續使用低分子量肝素，會優於維生素K拮抗劑，而直接口服抗凝血劑可用在癌症非活動期病人，是否延長治療時間，須考量病人狀況、腫瘤種類，整體評估利益與風險來決定。近年來，直接口服抗凝血劑快速取代維生素K拮抗劑，用在非癌症相關靜脈血栓栓塞治療，但是在癌症病人的使用經驗有限。本文整理直接口服抗凝血劑在癌症病人靜脈血栓栓塞治療的第三期臨床試驗及統合分析的結果，並介紹此類藥物的特性、交互作用及藥物動力學，使醫護人員隨時監測及發現用藥問題，以提高抗凝血劑使用之安全性。

關鍵字

直接口服抗凝血劑 ； 癌症 ； 靜脈血栓栓塞

並列摘要

Cancer patients are at risk of developing venous thromboembolism (VTE), resulting in increased recurrence of VTE, bleeding, mortality and economic burden. Most guidelines recommend that the initial therapy should include low molecular weight heparin (LMWH). LMWH therapy for the first 3-6 months after acute VTE is superior to vitamin K antagonists (VKA). The subsequent extended-therapy of anticoagulation should be determined based on individualized benefit and risk, tolerability, patient preference and cancer activity. Recently, the direct oral anticoagulants (DOACs) are rapidly replacing VKA for the treatment of VTE in the general population, but the information about the role of DOACs in cancer-associated VTE is limited. We reviewed the results of a phase Ⅲ trial and meta-analysis of DOACs for VTE treatment in cancer patients and introduced the features, pharmacokinetics and side effects of DOACs, hoping not only to provide a new therapeutic direction for clinical care staff but also to improve the drug safety during anticoagulants therapy.

並列關鍵字

direct oral anticoagulants ； cancer ； venous thromboembolism

參考文獻

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