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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Caveats for primary VTE prophylaxis in ambulatory cancer patients

Caveats for primary VTE prophylaxis in ambulatory cancer patients
Patients and clinicians should be aware of (and able to accommodate) the following concerns:
Increased risk of bleeding:
  • Higher baseline bleeding risk in most cancer patients
  • Increased risk of gastrointestinal bleeding with gastrointestinal tumors
  • Increased risk of gynecologic bleeding with gynecologic tumors
  • Increased risk of intracerebral bleeding with brain tumors or brain metastases
  • Concomitant medications may further increase bleeding risk (eg, aspirin, NSAIDs)
Burdens of therapy:
  • Need to remember an additional daily or twice-daily medication
  • Cost may be prohibitive for some individuals
  • Individuals may need assistance with administration if LMW heparin is chosen
  • Bleeding complications may interfere with chemotherapy cycles
Possible need for temporary interruption of anticoagulation:
  • For thrombocytopenia (platelet count <50,000/microL) associated with myelosuppressive chemotherapy
  • For invasive procedures such as cancer surgery, stent placement, or central venous access device placement
Unknowns about benefit:
  • Some features of the Khorana score change over time (platelet count, hemoglobin, WBC count)
  • Risk reduction may depend on tumor type and other factors
  • Optimal duration of therapy is not known
  • Optimal dosing of anticoagulants is unknown in individuals with very high BMI (eg, >40 kg/m2)
This table does not apply to selected populations for whom anticoagulation is warranted, such as those undergoing surgical procedures with high VTE risk or those with multiple myeloma receiving an immunomodulatory drug and high-dose glucocorticoids. Some individuals may reasonably choose primary prophylaxis with a LMW heparin or with a direct factor Xa inhibitor if they have a high risk of VTE. Examples include:
  • Khorana score ≥3
  • Khorana score of 2 with a high value placed on avoiding VTE
  • Prior VTE not currently receiving anticoagulation
  • Severe immobility
Tools for estimating VTE risk are imprecise, but the Khorana score may be used; pancreatic cancer and gastric cancer give a Khorana score of at least 2.
VTE: venous thromboembolism; NSAID: nonsteroidal antiinflammatory drug; LMW: low molecular weight; WBC: white blood cell; BMI: body mass index.
Graphic 120158 Version 1.0

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