不同抗凝血劑在癌症病患 血栓症之預防的回顧性研究

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標題:	不同抗凝血劑在癌症病患血栓症之預防的回顧性研究 A Retrospective Study on Prevention of Thrombosis with Different Anticoagulants in Cancer Patients 口服抗凝血劑廣泛使用在預防血栓栓塞。維生素K拮抗劑（例如warfarin）是過去最常用的口服抗凝血劑。相較於warfarin，低分子量肝素（Low Molecular Weight Heparin, LMWH）和非維他命K拮抗劑口服抗凝血劑(non-vitamin K antagonist oral anticoagulants, NOACs)提供了新的抗凝血選項，尤其是後者在2015年開始有解毒劑之後。癌症患者是血栓症的好發群組，因此這些人更須利用抗凝血劑預防血栓的併發症，例如心房顫動(atrial fibrillation, AF)及靜脈栓塞(venous thromboembolism, VTE)。目前已經有許多的研究以NOACs來預防癌症患者合併心房顫動及中風，但有效性及安全性尚無相關之綜合性研究。此篇論文中，我們統合整理分析具有血栓問題的AF或VTE的癌症患者，比較這些臨床試驗中使用warfarin、LMWH及NOACs的有效性及安全性。利用PubMed資料庫搜尋，篩選了9篇從2017年1月至2020年1月之間臨床試驗中針對癌症患者在使用這些抗凝血劑期間發生AF或VTE的機率以及發生重大出血風險的結果進行分析。結果發現：使用NOACs的重大出血(Warfarin: 3.03~8.18%, NOACs: 0.93~7.92%)及腸胃道出血(Warfarin: 3.5~4.82%, NOACs: 1.0~4.7%)的風險比warfarin低，同時使用NOACs的癌症病患因AF併發的腦中風(Warfarin: 0.65~12.2%, NOACs: 0.37~5.06%)的比率也比非使用NOACs的為低。此外，NOACs對於VTE的預防 (LMWH: 4.5~11.3%, NOACs: 3.4~7.9%)比LMWH也有明顯的改善，但兩者在重大出血方面並無明顯的差別。綜合以上結果，NOACs在癌症病患的AF及VTE預防效果比warfarin及LMWH大致上均較優，而重大出血問題則是NOACs比warfarin少見。因此，在預防癌症病患因血栓合併的AF或VTE併發症，應可以建議使用藥物交互作用比warfarin較少或是使用比LMWH方便的NOACs。這些結果與非癌症病患顯示是類似。 Oral anticoagulants are widely used for long-term prevention of thromboembolism. Vitamin K antagonists, such as warfarin, were the most common oral anticoagulants in the past. Compared to warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) have offered new options for outpatients, who need long term uses of anticoagulation. This is especially true when the first antidote of NOACs was launched in 2015. Cancer patients are at high risk of thrombosis, such as atrial fibrillation (AF) and venous thromboembolic (VTE). Therefore, this population needs to use anticoagulants to prevent thrombotic complications. Warfarin and low molecular weight heparin (LMWH) were used most often, respectively. Several studies have investigated the effect of NOACs in cancer patients with AF and VTE. However, there is no comprehensive comparison on efficacy and safety between warfarin and NOACs or between LMWH and NOACs. A retrospective study was carried out to compare the efficacy and safety of warfarin and LMWH with NOACs in this population. The clinical studies between January 2017 and January 2020 from PubMed databases were filtered according to inclusive and exclusive criteria and applied to this study. Nine clinical trial researches in cancer patients with AF were chosen. The results showed that compared with warfarin, NOACs decreased the risks of major bleeding (Warfarin: 3.03~8.18%, NOACs: 0.93~7.92%) and gastrointestinal bleeding (Warfarin: 3.5~4.82%, NOACs: 1.0~4.7%). Incidence of ischemic stroke caused by AF in cancer patients after using NOACs was also lower than warfarin (warfarin: 0.65~12.2%, NOACs: 0.37~5.06%). In addition, the prevention of VTE by NOACs (LMWH: 4.5 ~ 11.3%, NOACs: 3.4 ~ 7.9%) was also significantly improved than LMWH, but there is no significant difference in major bleeding. In conclusion, the efficacy of prevention of AF and VTE in cancer patients by NOACs was better than warfarin and LMWH, respectively. However, the major bleeding rate was lower in NOACs than warfarin. Therefore, uses of NOACs to prevent AF and VTE in cancer patients can be recommended to replace warfarin in order to reduce drug-drug and food-drug interaction concern.
作者:	黃玉瑜
貢獻者:	藥學系施美份
關鍵字:	低分子量肝素非維他命 K 拮抗劑口服抗凝血劑癌症心房顫動靜脈血栓栓塞症新型口服抗凝血劑 Warfarin Low Molecular Weight Heparin non vitamin K antagonist oral anticoagulants cancer Atrial fibrillation Venous thromboembolism
日期:	2020
上傳時間:	2022-10-21 10:31:50 (UTC+8)
關聯:	學年度：108， 54頁
顯示於類別:	[藥學系(所)] 博碩士論文

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