利伐沙班与低分子肝素预防肿瘤血栓有效性和安全性分析

摘要/Abstract

摘要： 目的评估利伐沙班与低分子肝素（LMWH）用于肿瘤血栓预防的有效性和安全性,以期为临床使用抗凝药预防肿瘤血栓提供参考。方法回顾性分析玉林市红十字会医院2022年6月—2023年3月恶性肿瘤患者193例,分为利伐沙班组（n=98）,LMWH组（n=95）,比较分析两组患者用药后1个月内及6个月内血栓发生率、出血发生率、死亡率。结果两组用药后1个月内及随访6个月内血栓发生率、出血发生率、死亡率比较,差异均无统计学意义（P>0.05）。结论与低分子肝素相比,利伐沙班用于恶性肿瘤血栓预防的有效性与安全性相当,或可作为拒绝或无法耐受皮下注射的合理替代药物。

关键词: 利伐沙班, 低分子肝素, 预防, 肿瘤血栓

Abstract: Objective To assess the efficacy and safety of rivaroxaban compared to low molecular weight heparin (LMWH) for thromboprophylaxis in cancer patients, aiming to provide clinical guidance on anticoagulant therapy for preventing cancer-related thrombosis. Methods A retrospective analysis was conducted involving 193 patients with malignant tumors from Yulin Red Cross Hospital between June 2022 and March 2023. Patients were divided into the rivaroxaban group (n=98) and the LMWH group (n=95). The incidence of thrombosis, bleeding, and mortality within one month and six months post-treatment were compared between the two groups. Results There were no statistically significant differences in the rates of thrombosis, bleeding, or mortality between the two groups at one month and during the six-month follow-up(P>0.05). Conclusion Rivaroxaban demonstrates comparable efficacy and safety to LMWH for thromboprophylaxis in malignant tumors,or can be used as a reasonable alternative to refusal or inability to tolerate subcutaneous injection.

Key words: rivaroxaban, low molecular weight heparin, prevention, cancer-related thrombosis

中图分类号:

R273

朱小丽. 利伐沙班与低分子肝素预防肿瘤血栓有效性和安全性分析[J]. 中华养生保健, 2025, 43(8): 47-51.

ZHU Xiao-li. Comparative Analysis of the Efficacy and Safety of Rivaroxaban versus Low Molecular Weight Heparin for Thromboprophylaxis in Cancer-Associated Thrombosis[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(8): 47-51.

参考文献

[1] KEY N S, KHORANA A A, KUDERER N M, et al.Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update[J].J Clin Oncol. 2023,41(16):3063-3071.
[2] LINDER M, EKBOM A, BROBERT G, et al.Comparison of rivaroxaban and low molecular weight heparin in the treatment of cancer-associated venous thromboembolism: a Swedish national population-based register study[J].J Thromb Thrombolysis,2024,57(6):673-983.
[3] STREIFF M B, HOLMSTROM B, ANGELINI D, et al.Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw.2021,19(10):1181-1201.
[4] 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.
[5] Górnicki T, Bułdyś K, Zielińska D, et al.Direct-Acting Oral Anticoagulant Therapy in Cancer Patients-A Review[J].Cancers (Basel). 2023,15(10):2697.
[6] PAPAKONSTANTINOU P E, TSIOUFIS C, KONSTANTINIDIS D, et al.Anticoagulation in Deep Venous Thrombosis: Current Trends in the Era of non-Vitamin K Antagonists Oral Anticoagulants[J].Curr Pharm Des,2020,26(23):2692-2702.
[7] LEE L H, DANCHAIVIJITR P, UAPRASERT n, et al. Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian Patients[J].Exp Hematol Oncol,2022,11(1):79.
[8] 胡佳丽,项丽婷,戚红萍,等.肿瘤化疗患者PICC相关性上肢静脉血栓形成时间及其影响因素分析[J].中国现代医学杂志,2021,31(6):51-57.
[9] FALANGA A, AY C, DI NISIO M, et al.Venous thromboembolism in cancer Patients: ESMO Clinical Practice Guideline[J].Ann Oncol,2023,34(5):452-467.
[10] KIMPTON M, CARRIER M.Efficacy and safety of Xa inhibitors for the treatment of cancer-associated venous thromboembolism[J].Expert Opin Drug Saf,2019,18(4):313-320.
[11] HUA D T.Clinical guideline highlights for the hospitalist: Prevention and treatment of venous thromboembolism in hospitalized patients with cancer[J].Hosp Med,2022,17(8):641-643.
[12] FARGE D.2022 international clinical Practice guidelines for the treatment and Prophylaxis of venous thromboembolism in Patients with cancer, including Patients with COVID-19[J].Lancet Oncol,2022,23(7):e334-e347.
[13] 蔡亮,丁勇,周旻,等.利伐沙班与传统抗凝药物在80岁以上静脉血栓栓塞症患者中的有效性与安全性对比[J].中国临床医学,2019, 26(2):272-276.
[14] 李雪梅,徐文坚,卢铨广.新型口服抗凝药治疗肿瘤相关静脉血栓栓塞症网状Meta分析[J].中国药业,2024,33(1):116-122.
[15] 梁婷,黄溯源,吴建博,等.利伐沙班致出血风险因素分析及预测[J].中国医院药学杂志,2021,41(3):277-281.
[16] 李博,陈丽霞,饶敏超.利伐沙班和低分子量肝素钙预防肿瘤患者深静脉血栓的有效性和安全性对比[J].中国医学创新,2023,20(26):135-138.
[17] 李杨. 探讨利伐沙班对胃肠道恶性肿瘤并发静脉血栓栓塞症围手术期预防性抗凝的有效性和安全性[J].临床和实验医学杂志,2023,22(14):1504-1507.
[18] 孙雪,郭彩会,宋浩静,等.利伐沙班致出血不良反应的国内外文献分析[J].中国新药杂志,2021,30(21):2003-2008.