肿瘤与血栓讲义资料.pptVIP

The cumulative rate of symptomatic recurrent VTE at 6 months was 17.4% in the oral anticoagulant group compared with 8.8% in the dalteparin group, a 52% relative risk reduction in favor of dalteparin.1 1. Lee AYY, Levine MN, Baker RI, et al. – the CLOT Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of  recurrent venous thromboembolism in patients with cancer. N Eng J  Med 2003;349:146-153. Thromboprophylaxis with dalteparin in cancer patients following abdominal surgery - safety Bleeding complications Dalteparin 2,500 IU Dalteparin 5,000 IU p All patients 2.7% 4.7% 0.02 Cancer patients 3.6% 4.6% Ns Non-cancer patients 0.9% 5.0% 0.01 Bergqvist et al. 1995 Three major trials with Fragmin in oncology Prolonged prophylaxis with Fragmin after major abdominal surgery (FAME) Randomized comparison of LMWH versus oral anticoagulant therapy for long-term anticoagulation in cancer patients with venous thromboembolism (CLOT) Fragmin advanced malignancy outcome study (FAMOUS) FAME: study design Major abdominal surgery with and without malignancy Bilateral venography(assessor-blinded) 7 Days 21 Days TP with dalteparin(5,000 IU sc od) + TED Prolonged TP dalteparin (5,000 IU sc od)  No TP R All VTE n=165 n=178 Incidence of all VTE 28 days after major abdominal surgery RRR: 55% (95% CI: 15% – 76%) 7.3% 16.2% 0 2 4 6 8 10 12 14 16 18 Incidence of all VTE (%) Prolonged (28-day) TP with dalteparin Short-term (7-day) TP with dalteparin P= 0.01 NNT: 12 (7 – 44) Unpublished data, presented at ISTH 2003 Proximal DVT Incidence of proximal DVT 28 days after major abdominal surgery RRR: 77% (95% CI: 22% – 93%) 1.8% 8.0% 0 2 4 6 8 10 n=165 n=175 Incidence of proximal DVT (%) Prolonged (28-day) TP with dalteparin Short-term (7-day) TP with dalteparin P = 0.009 NNT: 17 (10 – 59) Unpublished data, presented at ISTH 2003 All DVT 7.3% 14.9% 0 2 4 6 8 10 12 14 16 18 n=165 n=175 Incidence of all DVT (%) Prolonged (28-day) TP with dalteparin Sho