tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2025-15-3s1-60-65tumors-1507Research ArticleСтатьиВенозная тромбоэмболия. Что нас ждет впереди?https://orcid.org/0000-0003-4706-2439СомоноваО. В.

Сомонова Оксана Васильевна

115478 Москва, Каширское шоссе, 23

somonova@mail.ruhttps://orcid.org/0000-0001-6975-4562ЕлизароваА. Л.

Елизарова Анна Львовна

115478 Москва, Каширское шоссе, 23

ФГБУ «Научный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииRussian Federation202530112025153s16065Copyright © Сомонова О.В., Елизарова А.Л., 20252025Сомонова О.В., Елизарова А.Л.Сомонова О.В., Елизарова А.Л.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/1507

Тромбоэмболические осложнения у больных злокачественными новообразованиями встречаются в 7–11 раз чаще, чем у больных другими заболеваниями и занимают одно из лидирующих мест среди причин смерти. До недавнего времени для лечения и профилактики тромбоэмболических осложнений у больных злокачественными новообразованиями применялись низкомолекулярные гепарины (НМГ). Однако в настоящее время наиболее перспективными препаратами являются прямые оральные антикоагулянты (ПОАК), в частности, апиксабан и ривароксабан, которые заняли уверенную позицию в лечении и вторичной профилактике ВТЭО у онкологических больных благодаря ряду проведенных исследований по оценке их эффективности и безопасности у онкопациентов. Так, рандомизированное исследование Select-D показало, что в группе пациентов, получавших ривароксабан, частота рецидивов ВТЭО была ниже, чем частота рецидивов у пациентов, получавших далтепарин. При этом наблюдалась сопоставимая частота больших кровотечений. В другом рандомизированном клиническом исследовании CARAVAGGIO был продемонстрирован благоприятный профиль эффективности и безопасности терапии ВТЭО апиксабаном у онкологических больных, включая пациентов с опухолями ЖКТ и хронической болезнью почек. В представленном мета-анализе 65 исследований реальной клинической практики пациентов с тромбозом глубоких вен и тромбоэмболии легочной артерии (ТГВ/ТЭЛА) (2022 г.) было показано, что применение апиксабана и ривароксабана связано с более низким риском повторных ВТЭ и больших кровотечений по сравнению со стандартом лечения. В рекомендациях NCCN, ASCO ПОАК рассматриваются в качестве одного из вариантов терапии пациентов с активным злокачественным новообразованием и подтвержденными проксимальным ТГВ и ТЭЛА. В рекомендациях RUSSCO для лечения онкологических пациентов c тромбоэмболическими осложнениями ПОАК названы стандартом терапии в тех случаях, когда эти препараты могут быть назначены с первых дней лечения. Однако исследователи не останавливаются на достигнутых результатах. В настоящее время проводятся новые рандомизированные клинические исследования для проверки эффективности и безопасности антикоагулянтов, ингибирующих фактор XI и фактор XII у пациентов злокачественными новообразованиями.

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The authors declare that there are no conflicts of interest present.