2018SIMI意见书_癌症患者静脉血栓栓塞的预防和治疗.pdfVIP

Internal and Emergency Medicine /10.1007/s11739-018-1956-1 IM - REVIEW Position paper of the Italian Society of Internal Medicine (SIMI) on prophylaxis and treatment of venous thromboembolism in patients with cancer 1 2 1 3 4 Domenico Prisco  · Antonella Tufano  · Caterina Cenci  · Pasquale Pignatelli  · Francesca Santilli  · 2 5 Giovanni Di Minno  · Francesco Perticone Received: 10 August 2018 / Accepted: 18 September 2018 © Società Italiana di Medicina Interna 2018 Abstract Cancer patients are at high risk of developing thrombotic events, including venous thromboembolism (VTE) [deep venous thrombosis (DVT) and pulmonary embolism (PE)], and arterial thrombosis. DVT and PE represent the second leading cause of death in cancer patients; moreover, the development of thromboembolic events in cancer patients is linked to a greater need of hospitalization and frequency of side efects during treatment, in particular bleeding, and to an increased risk of recurrence during and following antithrombotic therapy. The thromboembolic risk may be diferent in diferent subgroups of cancer population, being highest in patients with metastatic disease, patients with pancreas, stomach, kidney or primary brain cancer, or during therapeutic interventions or surgery. This document focuses on several relevant topics including the epidemiology and pathogenesis of cancer-associated VTE, the current and future strategies of primary prevention and anticoagulant treatment, and the management of bleeding complications. The main literature data are discussed in detail, including, when available, evidence from randomized clinical trials and meta-analyses, international guidelines statements, the results of recently published trials comparing direct oral anticoagulants to low molecular weight