癌症患者静脉血栓栓塞症的危险因素NCCN指南2016v1

发表者：张品良人已读

Cancer-Associated Venous Thromboembolic Disease NCCN Guidelines Version 1.2016 癌症相关静脉血栓栓塞症NCCN指南2016年第1版

VTE RISK FACTORS IN CANCER PATIENTS癌症患者VTE危险因素

General patient risk factors 患者的一般危险因素

* Active cancer *癌症活跃

* Advanced stage of cancer *癌症晚期

* Cancer types at higher risk: *更高风险的肿瘤类型：

▶ Brain ▶脑

▶ Pancreas ▶胰腺

▶ Stomach ▶胃

▶ Bladder ▶膀胱

▶ Gynecologic ▶妇科

▶ Lung ▶ 肺

▶ Lymphoma ▶淋巴瘤

▶ Myeloproliferative neoplasms ▶骨髓增殖性肿瘤

▶ Kidney ▶肾

▶ Metastatic cancers ▶转移癌

* Regional bulky lymphadenopathy with extrinsic vascular compression *局部大块淋巴结病变伴外部血管压迫

* Familial and/or acquired hypercoagulability (including pregnancy) *家族性和/或获得性高凝状态(包括妊娠)

* Medical comorbidities: Infection, renal disease, pulmonary disease, congestive heart failure, arterial thromboembolism *并存内科疾病感染、肾病、肺病、充血性心力衰竭、动脉血栓栓塞

* Poor performance status *一般情况差

* Older age *老年

High-risk outpatients on chemotherapy, based on combinations of the following risk factors 化疗的高危门诊患者，具有下列危险因素

* Active cancers associated with high incidence of VTE: Stomach, pancreas, lung, lymphoma, gynecologic, bladder, and testicular *癌症活跃与VTE的发病率高有关：胃、胰腺、肺、淋巴瘤、妇科、膀胱和睾丸

* Prechemotherapy platelet count >300,000/mcL *化疗前血小板计数>300000/mcL

* Prechemotherapy white blood cell (WBC) >11,000/mcL *化疗前外周血白细胞（WBC）>11000/mcL

* Hemoglobin<10 g/dL *血红蛋白<10g/dL

* Use of erythropoiesis-stimulating agents *使用促红细胞生成素

* Body mass index (BMI) 35 kg/m2 or greater ＊身体质量指数（BMI）≥35kg/㎡

* Prior VTE *既往VTE

Treatment-related risk factors 治疗相关的危险因素

* Major surgery *大手术

* Central venous catheter/IV catheter ＊中心静脉导管/静脉导管

* Chemotherapy such as: *化疗如：

▶ Thalidomide/lenalidomide/pomalidomide plus high-dose dexamethasone ▶沙利度胺/来那度胺/泊马度胺加大剂量地塞米松

* Exogenous hormonal therapies such as: *外原性激素治疗如：

▶ Hormone replacement therapy (HRT) ▶ 激素替代治疗(HRT)

▶ Contraceptives ▶避孕药

▶ Tamoxifen/raloxifene ▶他莫昔芬/雷洛昔芬

▶ Diethylstilbestrol ▶己烯雌酚

Modifiable risk factors 可缓和的危险因素

* Smoking, tobacco *吸烟，烟草

* Obesity *肥胖

* Activity level/exercise *活动水平/运动

VTE RISK FACTORS IN CANCER PATIENTS 癌症患者VTE危险因素

Risk Assessment Model for the Management of Venous Thromboembolism in Multiple Myeloma Patients Treated with Thalidomide, Lenalidomide or Pomalidomide 对于接受沙利度胺、来那度胺或泊马度胺治疗的多发性骨髓瘤患者静脉血栓栓塞处理的危险性评估模型

Risk factors危险因素

Recommended action推荐措施

Individual risk factors个人危险因素

* Obesity (BMI ≥30 kg/m2) *肥胖症(BMI≥30kg/㎡)

* Prior VTE *既往VTE

* CVAD or pacemaker* CVAD或起搏器

* Associated disease: ＊相关疾病：

▶ Cardiac disease ▶心脏病

▶ Chronic renal disease ▶慢性肾病

▶ Diabetes ▶糖尿病

▶ Acute infection ▶急性感染

▶ Immobilization ▶制动

* Surgery: *手术：

▶ General surgery ▶普通外科

▶ Any anesthesia ▶任何麻醉

▶ Trauma ▶创伤

* Use of erythropoietin *使用促红细胞生成素

* Blood clotting disorders ＊凝血障碍

No risk factor or only one individual/myeloma risk factor: 无危险因素或只有一个个人/骨髓瘤危险因素：

* Aspirin 81–325 mg once daily *阿司匹林81-325mg qd

≥2 individual/myeloma risk factors: ≥2个个人/骨髓瘤危险因素：

* LMWH (equivalent to enoxaparin 40 mg once daily; *LMWH(相当于依诺肝素40mg qd；

or或

* Full-dose warfarin (target INR 2–3) *全量华法林(目标INR2-3)

Myeloma-related risk factors骨髓瘤相关的危险因素

* Diagnosis of myeloma, per se *骨髓瘤诊断本身

* Hyperviscosity *高黏血症

Myeloma therapy骨髓瘤治疗

* IMiD in combination with: *IMiD联合：

▶ High-dose dexamethasone

(≥480 mg per month) ▶大剂量地塞米松（每月≥480mg）▶多柔比星

▶ Doxorubicin ▶多药化疗

▶ Multiagent chemotherapy

Therapies as described in the left column: 如左侧栏所述治疗：

* LMWH (equivalent to enoxaparin 40 mg once daily); *LMWH(相当于依诺肝素40mg qd)；

or或

* Full-dose warfarin (target INR 2–3) *全量华法林(目标INR2-3)

VTE RISK FACTORS IN CANCER OUTPATIENTS 门诊癌症患者VTE危险因素

Khorana Predictive Model For Chemotherapy-Associated VTE

Khorana预测模型用于化疗相关的静脉血栓栓塞

Patient Characteristic患者特征	Risk Score风险评分
* Site of primary cancer ＊原发癌部位
▶ Very high risk (stomach, pancreas) ▶很高危（胃、胰腺）	2
▶ High risk (lung, lymphoma, gynecologic, bladder, testicular) ▶高危(肺、淋巴瘤、妇科、膀胱、睾丸)	1
* Prechemotherapy platelet count 350 x 10^9/L or higher*化疗前血小板计数350×10^9/L或更高	1
* Hemoglobin level less than 10 g/dL or use of red cell growth factors*血红蛋白水平＜10g/dL或使用红细胞生长因子	1
* Prechemotherapy leukocyte count higher than 11 x 10^9 /L *化疗前白细胞计数＞11×10^9/L	1
* BMI 35 kg/m2 or higher *体重指数≥35kg/㎡	1