Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum10988610.26442/20751753.2022.6.201724ArticlesСтатьиReview ArticleCancer-associated thrombosis during chemotherapy: treatment and prevention: A reviewРак-ассоциированный тромбоз при проведении химиотерапии: лечение и профилактикаhttps://orcid.org/0000-0002-1836-0851KorolevaIrina A.КоролеваИрина Альбертовна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, врач-онколог, проф. каф. клинической медицины последипломного образования

korolevaia_samara@mail.ruhttps://orcid.org/0000-0002-2783-9493KoppMikhail V.КоппМихаил Валерьевич
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., врач-онколог

korolevaia_samara@mail.ruMedical University “Reaviz”ЧУ ООВО «Медицинский университет “Реавиз”»150620222464224281508202215082022Copyright ©; 2022, Consilium MedicumCopyright ©; 2022, ООО "Консилиум Медикум"2022Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/109886

Cancer-associated thrombosis is a significant problem today for both oncologists and vascular surgeons. In patients with malignant neoplasms the incidence of symptomatic venous thromboembolism (VTE) is 4–7 times higher than in the general population. The presence of distant metastases in solid tumors increases the risk of VTE. Most often, VTE develop in pancreatic cancer and stomach cancer. Chemotherapy increases the risk of developing VTE. Low-molecular-weight heparin and direct oral anticoagulants are used for the treatment of VTE in patients with chemotherapy. The results of the СARAVAGGIO study demonstrated that apixaban is not inferior to dalteparin in the treatment of VTE in patients with active cancer and does not increase the risk of bleeding. Before starting chemotherapy, it is necessary to assess the risk of developing VTE using the Khorana risk score. Outpatient patients with high-risk cancer (Khorana score >2 before the start of a new systemic chemotherapy regimen) may be prescribed thromboprophylaxis with low molecular weight heparin. The idea of using direct oral anticoagulants seems promising, but so far it is beyond the scope of approved indications.

Рак-ассоциированный тромбоз является сегодня значимой проблемой как для онкологов, так и сосудистых хирургов. У пациентов со злокачественными новообразованиями частота возникновения симптомных венозных тромбоэмболических осложнений (ВТЭО) в 4–7 раз выше, чем в общей популяции. Наличие отдаленных метастазов при солидных опухолях повышает риск венозных тромбозов. Наиболее часто ВТЭО развиваются при раке поджелудочной железы и раке желудка. Химиотерапия увеличивает риск развития ВТЭО. Для лечения ВТЭО у больных при проведении химиотерапии используют низкомолекулярные гепарины и прямые оральные антикоагулянты. Результаты исследования СARAVAGGIO продемонстрировали, что апиксабан не уступает дальтепарину в лечении ВТЭО у больных активным раком и не увеличивает риск кровотечений. Перед началом химиотерапии необходимо оценить риск развития ВТЭО, используя шкалу Khorana. Амбулаторным пациентам с раком высокого риска (оценка по шкале Khorana >2 до начала нового режима системной химиотерапии) может быть назначена тромбопрофилактика низкомолекулярным гепарином. Представляется перспективной идея использования прямых оральных антикоагулянтов, но пока это за рамками одобренных показаний.

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