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Erschienen in: best practice onkologie 10/2020

07.10.2020 | Direkte orale Antikoagulanzien | CME-Topic

Tumorassoziierte venöse Thromboembolie – Pathogenese, Diagnose, Prävention und Therapie

verfasst von: Prof. Dr. H. Riess

Erschienen in: best practice onkologie | Ausgabe 10/2020

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Zusammenfassung

Bei Tumorpatienten sind tiefe Venenthrombosen und Lungenembolien – trotz angewandter primärpräventiver Maßnahmen – häufige, die Lebensqualität und Prognose beeinträchtigende Komplikationen. Aufgrund der oft oligo- bis asymptomatischen Entstehung ist ihre Diagnostik erschwert. Die Therapie unterscheidet sich wesentlich vom Vorgehen bei Nichttumorpatienten. Die Leitlinien empfehlen eine prolongierte, regelhaft über 3 Monate hinausgehende Antikoagulation unter Berücksichtigung des Malignomverlaufs. Alternativ zur parenteralen Gabe niedermolekularer Heparine stehen nun auch evidenzbasiert orale Faktor-Xa-Inhibitoren für die Initialtherapie und Sekundärprophylaxe zur Verfügung. Bei der patientenspezifischen Entscheidung über Art, Dauer und Intensität der Antikoagulation bedarf die therapiebedingte Zunahme eines bei Malignompatienten vorbestehend erhöhten Blutungsrisikos besonderer Berücksichtigung.
Literatur
1.
Zurück zum Zitat Decousus H, Quere I, Presles E et al (2010) Superficial venous thrombosis and venous thrombosis a large prospective epidemiologic study. Ann Intern Med 152:218–224PubMed Decousus H, Quere I, Presles E et al (2010) Superficial venous thrombosis and venous thrombosis a large prospective epidemiologic study. Ann Intern Med 152:218–224PubMed
2.
Zurück zum Zitat Fuentes HE, Tafur AJ, Caprini JA (2016) Cancer-associated thrombosis. Dis Mon 62:121–158PubMed Fuentes HE, Tafur AJ, Caprini JA (2016) Cancer-associated thrombosis. Dis Mon 62:121–158PubMed
3.
Zurück zum Zitat Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC (2013) Epidemiology of cancer-associated venous thrombosis. Blood 122:1712–1723PubMed Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC (2013) Epidemiology of cancer-associated venous thrombosis. Blood 122:1712–1723PubMed
5.
Zurück zum Zitat Khorana AA, Francis CW, Culakova E et al (2007) Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 5:632–634PubMed Khorana AA, Francis CW, Culakova E et al (2007) Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 5:632–634PubMed
6.
Zurück zum Zitat Cohen AT, Katholing A, Rietbrock S et al (2017) Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A populationbased cohort study. Thromb Haemost 117:57–65PubMed Cohen AT, Katholing A, Rietbrock S et al (2017) Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A populationbased cohort study. Thromb Haemost 117:57–65PubMed
7.
Zurück zum Zitat Ay C, Pabinger I, Cohen A (2017) Cancer associated thromboembolism: burden, mechanisms and management. Thromb Haemost 117:219–230PubMed Ay C, Pabinger I, Cohen A (2017) Cancer associated thromboembolism: burden, mechanisms and management. Thromb Haemost 117:219–230PubMed
8.
Zurück zum Zitat Carrier M, Righini M, Wells PS et al (2010) Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost 8:1716–1722PubMed Carrier M, Righini M, Wells PS et al (2010) Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost 8:1716–1722PubMed
9.
Zurück zum Zitat Khorana AA, Soff GA, Kakkar AK et al (2019) Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med 380:720–728PubMed Khorana AA, Soff GA, Kakkar AK et al (2019) Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med 380:720–728PubMed
11.
Zurück zum Zitat Riess H, Pabinger-Fasching I, Alt-Epping B et al (2019) Venöse Thromboembolien (VTE) bei Tumorpatienten. www.onkopedia.com. Zugegriffen: 19. Juli 2019 Riess H, Pabinger-Fasching I, Alt-Epping B et al (2019) Venöse Thromboembolien (VTE) bei Tumorpatienten. www.​onkopedia.​com. Zugegriffen: 19. Juli 2019
12.
Zurück zum Zitat Khorana AA, Francis CW (2018) Risk prediction of cancer-associated thrombosis: appraising the first decade and developing the future. Thromb Res 164:S70–S76PubMed Khorana AA, Francis CW (2018) Risk prediction of cancer-associated thrombosis: appraising the first decade and developing the future. Thromb Res 164:S70–S76PubMed
13.
Zurück zum Zitat Khorana AA, Otten HM, Zwicker JI et al (2014) Prevention of venous thromboembolism in cancer outpatients: guidance from the SSC of the ISTH. J Thromb Haemost 12:1928–1931PubMed Khorana AA, Otten HM, Zwicker JI et al (2014) Prevention of venous thromboembolism in cancer outpatients: guidance from the SSC of the ISTH. J Thromb Haemost 12:1928–1931PubMed
14.
Zurück zum Zitat Carrier M, Abou-Nassar K, Mallick R et al (2019) Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 380:711–719PubMed Carrier M, Abou-Nassar K, Mallick R et al (2019) Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 380:711–719PubMed
15.
Zurück zum Zitat Farge D, Frere C, Ay C et al (2019) 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 20:566–581 Farge D, Frere C, Ay C et al (2019) 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 20:566–581
16.
Zurück zum Zitat Key NS, Khorana AA, Kuderer NM et al (2019) Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical practice guideline update. J Clin Oncol 38:496–520PubMed Key NS, Khorana AA, Kuderer NM et al (2019) Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical practice guideline update. J Clin Oncol 38:496–520PubMed
17.
Zurück zum Zitat Lee AY, Levine MN, Baker RI et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153PubMed Lee AY, Levine MN, Baker RI et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153PubMed
18.
Zurück zum Zitat Lee AYY, Kamphuisen PW, Meyer G et al (2015) Tinzaparin vs warfarin for for treatment of acute venous thromboembolism in patients with active cancer. JAMA 314:677–686PubMed Lee AYY, Kamphuisen PW, Meyer G et al (2015) Tinzaparin vs warfarin for for treatment of acute venous thromboembolism in patients with active cancer. JAMA 314:677–686PubMed
19.
Zurück zum Zitat Carrier M, Cameron C, Delluc A et al (2014) Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res 134:1214–1219PubMed Carrier M, Cameron C, Delluc A et al (2014) Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res 134:1214–1219PubMed
20.
Zurück zum Zitat Matzdorff A, Ledig B, Stuecker M, Riess H (2016) Practice patterns for prophylaxis and treatment of venous thromboembolism in German cancer patients. Oncol Res Treat 39:194–201PubMed Matzdorff A, Ledig B, Stuecker M, Riess H (2016) Practice patterns for prophylaxis and treatment of venous thromboembolism in German cancer patients. Oncol Res Treat 39:194–201PubMed
21.
Zurück zum Zitat Raskob GE, van Es N, Verhamme P et al (2018) Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 378:615-624. https://doi.org/10.1056/NEJMoa1711948 Raskob GE, van Es N, Verhamme P et al (2018) Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 378:615-624. https://​doi.​org/​10.​1056/​NEJMoa1711948
22.
Zurück zum Zitat Young AM, Marshall A, Thirlwall J et al (2018) Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 36:2017–2023PubMed Young AM, Marshall A, Thirlwall J et al (2018) Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 36:2017–2023PubMed
23.
Zurück zum Zitat McBane R II, Wysokinski WE, Le-Rademacher JG et al (2020) Apixaban and dalteparin in active malignancy associated venous thromboembolism: The ADAM VTE Trial. J Thromb Haemost 18:411–421PubMed McBane R II, Wysokinski WE, Le-Rademacher JG et al (2020) Apixaban and dalteparin in active malignancy associated venous thromboembolism: The ADAM VTE Trial. J Thromb Haemost 18:411–421PubMed
24.
Zurück zum Zitat Agnelli G, Becattini C, Meyer G et al (2020) Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 382:1599–1607PubMed Agnelli G, Becattini C, Meyer G et al (2020) Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med 382:1599–1607PubMed
25.
Zurück zum Zitat Beyer-Westendorf J, Klamroth R, Kreher S et al (2019) Non-Vitamin K antagonist oral anticoagulants (NOAC) as an alternative treatment option in tumor-related venous thromboembolism. Dtsch Arztebl Int 116:31–38PubMedPubMedCentral Beyer-Westendorf J, Klamroth R, Kreher S et al (2019) Non-Vitamin K antagonist oral anticoagulants (NOAC) as an alternative treatment option in tumor-related venous thromboembolism. Dtsch Arztebl Int 116:31–38PubMedPubMedCentral
26.
Zurück zum Zitat Riess H, Ay C, Bauersachs R et al (2018) Use of direct oral anticoagulants in patients with cancer: practical considerations for the management of patients with nausea or vomiting. The Oncol 23:822–839 Riess H, Ay C, Bauersachs R et al (2018) Use of direct oral anticoagulants in patients with cancer: practical considerations for the management of patients with nausea or vomiting. The Oncol 23:822–839
27.
Zurück zum Zitat Riess H, Prandoni P, Harder S et al (2018) Direct oral anticoagulants for the treatment of venous thromboembolism in cancer patients: Potential for drug-drug interactions. Crit Rev Oncol Hematol 132:169–179PubMed Riess H, Prandoni P, Harder S et al (2018) Direct oral anticoagulants for the treatment of venous thromboembolism in cancer patients: Potential for drug-drug interactions. Crit Rev Oncol Hematol 132:169–179PubMed
28.
Zurück zum Zitat Agnelli G, Buller HR, Cohen A et al (2013) Apixaban for extended treatment of venous thromboembolism. N Engl J Med 368:699–708PubMed Agnelli G, Buller HR, Cohen A et al (2013) Apixaban for extended treatment of venous thromboembolism. N Engl J Med 368:699–708PubMed
29.
Zurück zum Zitat Weitz J, Lensing AWA, Prins MH et al (2017) Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med 376:1211–1222PubMed Weitz J, Lensing AWA, Prins MH et al (2017) Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med 376:1211–1222PubMed
Metadaten
Titel
Tumorassoziierte venöse Thromboembolie – Pathogenese, Diagnose, Prävention und Therapie
verfasst von
Prof. Dr. H. Riess
Publikationsdatum
07.10.2020
Verlag
Springer Medizin
Erschienen in
best practice onkologie / Ausgabe 10/2020
Print ISSN: 0946-4565
Elektronische ISSN: 1862-8559
DOI
https://doi.org/10.1007/s11654-020-00249-w

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