癌症患者伴有血栓（含血栓复发和重复出血）的疑难病例管理指南

This article gives guidance on common clinical problems complicating the management of anticoagulation in patients with cancer-associated thrombosis (CAT). Although low molecular weight heparins (LMWHs) have improved patient outcomes and simplified therapy, high-quality evidence on the optimal management of CAT is lacking. This guidance statement will specifically address: (i) the treatment of recurrent venous thromboembolism (VTE) with dose escalation of LMWH; (ii) management in patients with thrombocytopenia; (iii) management in patients with active bleeding; and (iv) the role of inferior vena caval (IVC) filters. It will also discuss the use of novel oral anticoagulants (NOACs) for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Some of these topics are covered in published consensus guidelines [1-5], but the aim of this guidance statement is to outline expert experience and the biological rationale that may influence decision-making, and offer concrete approaches to the management of anticoagulation in individual cancer patients with these therapeutic challenges. Recognizing the lack of high-quality evidence in many of these areas, it is important for patients to be informed of the uncertainties, risks and benefits of the management plan, and for proper documentation of the discussion to be included in the medical chart.

全文地址：