新型口服抗凝药在肿瘤相关性血栓栓塞的研究进展

静脉血栓栓塞症（VTE）是肿瘤常见的并发症之一，也是肿瘤患者的第二大死因。虽然低分子肝素（LMWH）是治疗肿瘤相关VTE的首选方案，但是长期注射的不适与过高的费用，导致病人很难长期维持。新型口服抗凝药（NOACs）因其口服方便，相比华法林受食物药物影响小，且无需常规监测等优点而受到广泛关注。最近比较NOACs与LMWH治疗肿瘤相关性VTE的研究表明，NOACs在肿瘤相关性血栓（CAT）的疗效方面，不劣于LMWH，但有增加出血的风险。在某些肿瘤中，它们可能是LMWH合理的替代方案。本文总结了NOACs用于治疗和预防CAT的已完成或尚在进行的临床研究，后续研究将提供更多的证据指导NOACs应用。

Advances in the study of new oral anticoagulants in cancer-associated venous thromboembolism

Venous thromboembolism (VTE) is one of the common complications of cancer and the second cause of death in cancer patients. Low molecular weight heparin(LMWH) is the standard of care but the high cost and the inconvenience of daily injections have led to low persistence with therapy. New oral anticoagulants (NOACs) have recently emerged as a new therapeutic option due to the ease of administration, especially compared to warfarin. The patients do not have to do laboratory monitoring for NOACs and there is less food or drug interactions. Several large randomized clinical trials have been performed and indicated that specific NOACs are more effective in the treatment of cancer-associated VTE compared with LMWH, but might increase the risk of bleeding. In some kinds of tumors, NOACs will be the reasonable alternative agents in the management of cancer-associated VTE. This review summarizes the current evidences for NOACs in the prevention and treatment of CAT, and there are ongoing studies providing more evidences for NOACs in CAT as well.