Cem UZAL, Gülden BAYIR, Murat ÇALOĞLU, Mert SAYNAK, Yürüt Vuslat ÇALOĞLU

Kanser hastalarında düşük molekül ağırlıklı heparin'in sağkalım üzerine etkisi

Kanser ile venöz tromboemboli (VTE) gelişimi arasında iyi bilinen bir ilişki vardır. Yeni tanı alan tromboembolizm olgularının yaklaşık %20 kadarının malign hastalıkla ilişkili olduğu görülmektedir. Trombozun patogenezinde ise tümör hücreleri, homeostatik sistem ve hasta özellikleri arasındaki kompleks ilişkiler sorumlu tutulmaktadır. Akut VTE'nin önlenmesinde ve tedavisinde başlıca dayanak antikoagülanlardır. Kanser hastalarında hastalık daha kötü seyretmekte ve sıklıkla tedaviler yanıtsız kalabilmektedir. Son dönemlerde kanser hastalarında düşük molekül ağırlıklı heparinin (DMAH) sağkalım üzerine etkisini değerlendiren randomize çalışmalarda özellikle hastalığı ilerlememiş hastaların tedaviden faydalandığı gösterilmektedir. Bununla birlikte sonuçlar tartışmalıdır ve yeni çalışmalara ihtiyaç duyulmaktadır.

The effect of low molecular weight heparin on survival in patients with cancer

The association between cancer and venous thromboembolism (VTE) is well established. Of all new venous tromboembolism, approximately 20% are associated with active malignancy. In these cases, the pathogenic mechanisms of thrombosis involve a complex interaction between tumour cells, the haemostatic system, and charateristics of the patient. Anticoagulants are the mainstay therapy for the prevention and treatment of acute VTE. The natural history of VTE is more agressive and anticoagulant treatment failure is more frequent in cancer patients than in patients without cancer. Recently, the results of new prospective randomized clinical trials to evaluate the effect of low-molecular-weight heparin on cancer survival have become available. The results suggest a benefit from treatment, particularly in patients with nonadvanced disease. However, these results are not conclusive and require further research.

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