目的 使用Khorana评分评估住院恶性肿瘤患者静脉血栓栓塞症风险，比较不同血栓风险患者血栓预防措施实施情况。方法 选取2017年1月至2019年10月首都医科大学附属北京世纪坛医院住院恶性肿瘤患者为研究对象。查阅电子病历系统，收集患者一般资料、疾病相关资料、Khorana评分和血栓预防资料。结果 1834例患者中，Khorana评分中位数为2（1，2）分，评分为低、中和高危的患者分别占9.0%（165/1834）、70.0%（1284/1834）和21.0%（385/1834）。手术患者中， 低、中和高危患者分别占8.8%（83/941）、71.7%（675/941）和19.4%（183/941）。单纯化疗患者中， 低、中和高危患者分别占6.5%（18/679）、69.2%（193/279）和24.4%（68/279）。所有患者、手术患者和单纯化疗患者中，血栓预防措施总使用率分别为61.7%（1131/1834）、83.3%（784/941）和41.9%（117/279）。所有患者和手术患者中，不同风险级别者血栓预防措施总使用率存在差异（P=0.002，P=0.016）。化疗患者中，不同风险分级者血栓预防措施总使用率差异无统计学意义（P=0.060）。所有患者和手术患者中，不同风险分级者的单纯药物预防、单纯机械预防和药物联合机械预防分布差异无统计学意义（P=0.167，P=0.081）。结论 住院恶性肿瘤患者静脉血栓栓塞症风险较高，而血栓预防措施使用率不足。医护人员未完全根据血栓风险调整预防策略。医院人员应在评估血栓风险基础上，采取合适的预防策略，以减少恶性肿瘤患者血栓和出血事件的发生。
Abstract
To evaluate venous thromboembolism risk in hospitalized cancer patients using the Khorana score, and compare thromboprophylaxis strategies of cancer patients at different risk levels of venous thromboembolism. Methods Cancer patients hospitalized in a tertiary hospital in Beijing during January 2017 and October 2019 were enrolled. Electronic medical records were reviewed to obtain patient characteristics, Khorana score, and thromboprophylaxis information. Results The median Khorana score of 1834 patients was 2(1, 2). 9.0%(165/1834),70.0%(1284/1834), and 21.0%(385/1834) of these patients were classified as low, intermediate and high-risk, respectively. 8.8% (83/941), 71.7% (675/941), and 19.4% (183/941) of surgical patients were in low, intermediate, and high-risk groups, respectively. While in patients only receiving chemotherapy, 6.5%(18/679),69.2%(193/279), and 24.4%(68/279) were at low, intermediate and high-risk of venous thromboembolism, respectively. The overall thromboprophylaxis rates in all patients, surgical patients, and patients only receiving chemotherapy were 61.7% (1131/1834), 83.3% (784/941), and 41.9% (117/279), respectively. The overall thromboprophylaxis rates differed significantly among different risk levels of Khorana score in all patients and surgical patients (P=0.002,P=0.016). There was no significant difference in thromboprophylaxis rate among different risk levels of Khorana score in patients receiving chemotherapy (P=0.060). However, in all patients and surgical patients, the distribution of three prophylaxis strategies (pure pharmacologic prophylaxis, pure mechanical prophylaxis, pharmacologic and mechanical prophylaxis) have no significant difference among three risk levels of Khorana Score (P=0.167, P=0.081). Conclusion Hospitalized cancer patients were at a relatively high risk of venous thromboembolism, but the prescription of thromboprophylaxis was not enough. Medical staff did not adjust prophylaxis strategies according to the risk level of venous thromboembolism. Hence, medical staff should evaluate venous thromboembolism risk of cancer patients, and adopt appropriate prophylaxis strategies to reduce the incidence of bleeding and venous thromboembolism.
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1.郑荣寿, 孙可欣, 张思维, 等, 2015年中国恶性肿瘤流行情况分析［J］. 中华肿瘤杂志, 2019, 41(1):19-28.
2.KHORANA A A, FRANCI C W, CULAKOVA E, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy［J］. J Thromb Haemost, 2007, 5(3):632-634.
3.LLYMAN G H, ECKERT L, WANG Y, et al. Venous thromboembolism risk in patients with cancer receiving chemotherapy: a real-world analysis［J］. Oncologist, 2013, 18(12):1321-1329.
4.COHEN A T, KATHOLING A, RIETBROCK S, et al. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study［J］. Thromb Haemost, 2017, 117(1):57-65.
5.KHORANA A A, FRANCIS C W, CULAKOVA E, et al. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients［J］. Cancer, 2007, 110(10):2339-2346.
6.LLOYD A J, DEWILDE S, NOBLE S, et al. What impact does venous thromboembolism and bleeding have on cancer patients quality of life?［J］. Value Health, 2018, 21(4):449-455.
7.AY C, PABINGER I, COHEN AT. Cancer-associated venous thromboembolism: Burden, mechanisms, and management［J］. Thromb Haemost, 2017, 117(2):219-230.
8.李廷廷, 战翠萍, 崔久嵬. 癌症相关性血栓形成的病理机制进展［J］. 中国实验诊断学, 2019, 23(5):932-935.
9.ADELBORG K, CORRAINI P, DARVALICS B, et al. Risk of thromboembolic and bleeding outcomes following hematological cancers: a danish population-based cohort study［J］. J Thromb Haemost, 2019, 17(8):1305-1318.
10.BLOM J W, DOGGEN C J M, OSANTO S, et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis［J］. JAMA, 2005, 293(6):715-722.
11.ANGELINI D E, RADIVOYEVITCH T, MCCRAE K R, et al. Bleeding incidence and risk factors among cancer patients treated with anticoagulation［J］. Am J Hematol, 2019, 94(7):780-785.
12.KHORANA A A, KUDERER N M, CULAKOVA E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis［J］. Blood, 2008, 111(10):4902-4907.
13.PATELL R, RYBICKI L, MCCRAE K R, et al. Predicting risk of venous thromboembolism in hospitalized cancer patients: utility of a risk assessment tool［J］. Am J Hematol, 2017, 92(6):501-507.
14.石汉平, 赵青川, 王昆华, 等. 营养不良的三级诊断［J］. 中国癌症防治杂志, 2015, 7(5):313-319.
15.PARKER A, PETERSON E, LEE A Y Y, et al. Risk stratification for the development of venous thromboembolism in hospitalized patients with cancer［J］. J Thromb Haemost, 2018, 16(7):1321-1326.
16.HIRAIDE M, SHIGA T, MINAWA Y, et al. Identification of risk factors for venous thromboembolism and evaluation of Khorana venous thromboembolism risk assessment in Japanese lung cancer patients［J］. J Cardiol, 2020, 75(1):110-114.
17.GIUSTOZZI M, CURCIO A, WEIJS B, et al. Variation in the association between antineoplastic therapies and venous thromboembolism in patients with active cancer［J］. Thromb Haemost, 2020, 120(5):847-856.
18.LI M, GUO Q, HU W. Incidence, risk factors, and outcomes of venous thromboembolism after oncologic surgery: a systematic review and meta-analysis［J］. Thromb Res, 2019, 173:48-56.
19.邝允勋, 李佳玉, 何海龙, 等. Caprini风险评估模型预测恶性肿瘤住院患者深静脉血栓形成的确证性研究［J］. 中国肿瘤临床, 2019, 46(13):682-685.
20.中国临床肿瘤学会肿瘤与血栓专家委员会. 肿瘤相关静脉血栓栓塞症预防与治疗指南(2019版)［J］. 中国肿瘤临床, 2019, 46(13):653-660.
21.吴倩, 王淑芳, 徐旭娟. 护士癌性静脉血栓栓塞护理预防知信行现状调查［J］. 护理研究, 2015, 29(33):4122-4126.
22.ZWICKER J I, ROJAN A, CAMPIGOTTO F, et al. Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: a prospective, cross-sectional, multicenter study［J］. J Clin Oncol, 2014, 32(17):1792-1796.
23.KEY N S, KHORANA A A, KUDERER N M, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update［J］. J Clin Oncol, 2020, 38(5):496-520.
24.SAMAMA C M, BOUBLI L, COLOBY P, et al. Venous thromboembolism prophylaxis in patients undergoing abdominal or pelvic surgery for cancer-a real-world, prospective, observational French study: préobs［J］. Thromb Res, 2014, 133(6):985-992.
25.KAHN S R, MORRISON D R, DIENDERE G, et al. Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism［J］. Cochrane Database Syst Rev, 2018, 4: CD008201.
基金
国家重点研发计划（2017YFC1309204）
PDF(493 KB)
