循環器ジャーナル68巻4号

2020年10月発行

特集 抗血栓療法—日常臨床での疑問に応える Ⅲ．深部静脈血栓症・肺血栓塞栓症に対する抗血栓療法

がん関連静脈血栓塞栓症に対する抗凝固療法の注意点は？

著者： 山下侑吾¹ 坂本二郎²

所属機関： ¹京都大学医学部附属病院循環器内科 ²天理よろづ相談所病院循環器内科

ページ範囲：P.650 - P.657

Point
・「がん」は，「静脈血栓塞栓症」の重要な背景因子であり，「がん関連静脈血栓塞栓症」は，近年ますます重要になってきている．
・がん関連静脈血栓塞栓症は，高い再発リスクを有しており，再発予防のために長期的な抗凝固療法が必要となる．一方で，抗凝固療法に伴う出血リスクにも警戒が必要であり，がん患者では特に注意を要する．
・抗凝固療法は，再発と出血リスクのバランスを考慮したうえで，個々の症例において慎重に検討すべきであり，抗凝固薬を内服中は，患者の状態を注意深く観察し，その変化に応じて対応を考慮する必要がある．

参考文献

1) Trousseau A:Plegmasia alba dolens. Lectures on clinical medicine, delivered at the Hotel-Dieu, Paris 5:281-332, 1865

2) Varki A:Trousseau's syndrome:multiple definitions and multiple mechanisms. Blood 110:1723-1729, 2007

3) Sakamoto J, Yamashita Y, Morimoto T, et al:Cancer-Associated Venous Thromboembolism in the Real World-From the COMMAND VTE Registry. Circ J 83:2271-2281, 2019

4) Walker AJ, Card TR, West J, et al:Incidence of venous thromboembolism in patients with cancer-a cohort study using linked United Kingdom databases. Eur J Cancer 49:1404-1413, 2013

5) Prandoni P, Lensing AW, Büller HR, et al:Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 327:1128-1133, 1992

6) Prandoni P, Lensing AW, Piccioli A, et al:Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484-3488, 2002

7) Kim K, Yamashita Y, Morimoto T, et al:Risk Factors for Major Bleeding during Prolonged Anticoagulation Therapy in Patients with Venous Thromboembolism:From the COMMAND VTE Registry. Thromb Haemost 119:1498-1507, 2019

8) Lee AY, Levine MN, Baker RI, et al:Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146-153, 2003

9) Konstantinides SV, Torbicki A, Agnelli G, et al:2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033-3069, 2014

10) Kearon C, Akl EA, Ornelas J, et al:Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report. Chest 149:315-352, 2016

11) Raskob GE, van Es N, Verhamme P, et al:Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med 378:615-624, 2018

12) Young AM, Marshall A, Thirlwall J, et al:Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism:Results of a Randomized Trial（SELECT-D）. J Clin Oncol 36:2017-2023, 2018

13) McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, et al:Apixaban and dalteparin in active malignancy-associated venous thromboembolism:The ADAM VTE trial. J Thromb Haemost 18:411-421, 2019

14) Dentali F, Pegoraro S, Barco S, et al:Clinical course of isolated distal deep vein thrombosis in patients with active cancer:a multicenter cohort study. J Thromb Haemost 15:1757-1763, 2017

15) Yamashita Y, Shiomi H, Morimoto T, et al:Asymptomatic Lower Extremity Deep Vein Thrombosis-Clinical Characteristics, Management Strategies, and Long-Term Outcomes. Circ J 81:1936-1944, 2017