癌症病人發生靜脈栓塞 (venous thromboembolism, VTE) 風險相較於非癌症病人高，除了病生理不同外，癌症的狀態、治療以及病人特性都可能會影響VTE 的發生風險。抗凝血藥物是目前治療癌症相關VTE 之主要藥物，其中low-molecular-weight heparin 的療效和安全性已被充分瞭解，也是許多指引建議的標準治療藥物。直至近期，non-vitamin K antagonist oral anticoagulants 也漸漸因其方便、有效及可接受的安全性，被臨床醫療者所青睞。然而，因癌症病人同時有較高VTE 復發及出血風險，讓抗凝血藥物治療變得更複雜及具挑戰性。因此，癌症相關VTE 有必要根據病人栓塞與出血風險來制定個人化治療，而本文將回顧目前文獻，並提供實證醫學建議做為臨床應用。

 

Cancer patients are at higher risk of venous thromboembolism (VTE) than non-cancer patients. Furthermore, factors such as pathophysiological differences, cancer status, treatment and patient characteristics may affect the risk of VTE. Anticoagulants are currently the key drugs for the treatment of cancer-related VTE. Among them, the efficacy and safety of low-molecular-weight heparin have been fully understood, and it is also the standard treatment drug recommended by many guidelines. Until recently, non-vitamin K antagonist oral anticoagulants are gradually preferred to be used clinically due to its convenience, efficacy and acceptable safety. However, cancer patients have a relatively high risk of VTE recurrence and bleeding, the treatment of anticoagulants is more complicated and challenging. Therefore, according to the patient’s risk of embolism and bleeding to develop individualized treatment for cancer-related VTE is needed. In this article, we will review the current literature and provide evidence-based medical recommendations for clinical application.

 

Submitted for publication: 2023.2.24; Accepted for publication: 2023.7.18