肿瘤相关性静脉血栓栓塞症诊疗和治疗.pptVIP

1865年 * NCCN ASCO * NCCN-2010 ASCO-2007 维生素K拮抗剂（VKA） 国际标准化比值(INR)的变化 * 健康成年人，INR值大约1.0。有静脉血栓的患者的INR值一般应保持在2.0～2.5之间；有心房纤维性颤动的患者的INR值一般应保持在2.0～3.0之间。然而，理想的INR值一定要为每一个病人制定个性化指标。当INR值高于4.0时，提示血液凝固需要很长时间，这可能引起无法控制的出血，甚至死亡。而INR低于2.0不能提供有效的抗凝。 * * Patients with metastasized or locally advanced solid tumors were randomly assigned to receive a 6-week course of subcutaneous nadroparin or placebo. The primary efficacy analysis was based on time from random assignment to death. The primary safety outcome was major bleeding. In the a priori specified subgroup of patients with a life expectancy of 6 months or more at enrollment, the hazard ratio was 0.64 (95% CI, 0.45 to 0.90) with a median survival of 15.4 and 9.4 months, respectively. For patients with a shorter life expectancy, the hazard ratio was 0.88 (95% CI, 0.62 to 1.25） * Breast cancer was more frequent in the Fraxiparine? group, whereas colorectal and cervical cancers were seen more often in the placebo group. A small proportion of patients did not have metastatic disease. The types of locally advanced disease in this group included hepatocellular, oesophageal, and pancreatic cancer. * In the a priori specified subgroup of patients with a life expectancy of six months or above at enrolment, the hazard ratio for mortality was 0.64, with a median survival of 15.4 and 9.4 months in the Fraxiparine? and placebo groups, respectively. In patients with a shorter life expectancy, the hazard ratio of mortality was 0.88 (95% CI: 0.62 to 1.25). * Gemcitabine (GEM) and cisplatinum (CDDP) are active drugs in advanced pancreatic cancer. This pilot study was performed between November 1999 and July 2002 to assess the effects of adding Fraxiparine? (0.3 mL od) to the GEM plus CDDP combination in patients with advanced pancreatic cancer. A total of 42 consecutive patients were treated with GEM plus CDDP ± Fraxiparine?. Treatment was continued until progression or for a further 2 cycles after disease stabilisation (median: 6 c