Современные подходы к профилактике венозных тромбоэмболических осложнений у пациентов с активным раком
https://doi.org/10.21518/2307-1109-2022-12-2-44-62
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Аннотация
Онкологическое заболевание является одним из самых значимых факторов риска развития венозных тромбоэмболических осложнений (ВТЭО), которые объединяют тромбоз глубоких вен и тромбоэмболию легочной артерии. Из множества общеизвестных факторов риска ВТЭО только рак связан с 4-кратным возрастанием риска венозного тромбоза, а у онкологических больных, получающих химиотерапию, этот риск возрастает до 6,5 раза. Венозные тромбозы все чаще выявляются у онкологических больных и вносят значительный вклад в течение основного заболевания и смертность, особенно в сочетании с дополнительными факторами риска, наиболее значимые из которых – хирургическое вмешательство и химиотерапевтическое лечение. Профилактика и лечение ВТЭО у онкологических больных являются сложной задачей, и связано это в первую очередь с особенностями патогенеза рак-ассоциированного тромбоза, наличием дополнительных факторов риска, связанных с онкологическим заболеванием, высоким риском геморрагических осложнений, снижением функции почек и рецидивирующим характером течения ВТЭО. Аспекты безопасной профилактики остаются неотъемлемой частью ведения пациентов с активным раком. Наиболее уязвимые периоды в плане развития ВТЭО – это периоды пребывания пациента в стационаре для хирургического или терапевтического лечения, а также длительный период проведения химиотерапевтического лечения на амбулаторном этапе. Комплексный подход к профилактике ВТЭО у пациентов с раком должен предусматривать прежде всего тщательный отбор пациентов высокого риска на каждом этапе лечения злокачественного новообразования, именно эти пациенты в первую очередь выиграют от медикаментозной тромбопрофилактики. Лечение уже подтвержденного ВТЭО у онкологического пациента всегда сопряжено с дополнительными трудностями, которые связаны с лекарственными взаимодействиями и повышенным геморрагическим риском ввиду длительного использования лечебных доз антикоагулянтов, что может повлиять, в свою очередь, на эффективность химиотерапии или эффективность и безопасность антикоагулянтной терапии.
Ключевые слова
рак-ассоциированные венозные тромбозы,
медикаментозная тромбопрофилактика рак-ассоциированного венозного тромбоза,
химиотерапия,
фондапаринукс,
надропарин
При поддержке: статья подготовлена при поддержке компании Aspen
Об авторах
Ю. А. Федоткина
Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова
Россия
Россия
Федоткина Юлия Александровна, к.м.н., научный сотрудник отдела клинических проблем атеротромбоза
121552, Москва, ул. 3-я Черепковская, д. 15a
Е. П. Панченко
Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова
Россия
Россия
Панченко Елизавета Павловна, д.м.н., профессор, руководитель отдела клинических проблем атеротромбоза
121552, Москва, ул. 3-я Черепковская, д. 15a
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Рецензия
Для цитирования:
Федоткина Ю.А., Панченко Е.П. Современные подходы к профилактике венозных тромбоэмболических осложнений у пациентов с активным раком. Атеротромбоз. 2022;12(2):44-62. https://doi.org/10.21518/2307-1109-2022-12-2-44-62
For citation:
Fedotkina Yu.A., Panchenko E.P. Modern approaches to the prevention of venous thromboembolic complications in patients with active cancer. Aterotromboz = Atherothrombosis. 2022;12(2):44-62. (In Russ.) https://doi.org/10.21518/2307-1109-2022-12-2-44-62
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ISSN 2307-1109 (Print)
ISSN 2658-5952 (Online)
ISSN 2658-5952 (Online)
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