tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncowebtumors-554Research ArticleФУНДАМЕНТАЛЬНАЯ ОНКОЛОГИЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАFUNDAMENTAL ONCOLOGY AND EXPERIMENTAL MEDICINEТромбоз у онкологического больного и рак у пациента с тромбозом: как быть?СомоноваО. В.omonova@mail.ruЕлизароваА. Л.БорисенкоH. H.КорнюшенкоУ. А.ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения РФ.Russian Federation20181211201883s1110114Copyright © Сомонова О.В., Елизарова А.Л., Борисенко H.H., Корнюшенко У.А., 20182018Сомонова О.В., Елизарова А.Л., Борисенко H.H., Корнюшенко У.А.Сомонова О.В., Елизарова А.Л., Борисенко H.H., Корнюшенко У.А.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/554

Онкологические больные подвержены высокому риску тромботических осложнений, которые ухудшают исходы противоопухолевого лечения и занимают одно из лидирующих мест среди причин смерти. Тромбоз у онкологического пациента увеличивает риск смерти в 30 раз, что связано с развитием смертельной тромбоэмболии и более агрессивным течением опухолевого процесса. Ведущую роль в патогенезе тромботических осложнений играют нарушения в системе гемостаза, вызываемые как непосредственно опухолью, так и методами лечения. Низкомолекулярные гепарины (НМГ) являются основой специфической профилактики тромбоэмболических осложнений у онкологических больных. Применение низкомолекулярных гепаринов после операции и на фоне химиотерапии эффективно снижает частоту венозных тромбозов. НМГ являются препаратами первого выбора для лечения рак-ассоциированных тромбозов в течение первых 6 месяцев. Прямые оральные антикоагулянты (ПОАК) являются перспективными препаратами для приема внутрь и показаны для лечения и вторичной профилактики тромбозов у онкологических больных как приемлемая альтернатива.

онкологические больныетромботические осложнениянизкомолекулярные гепариныпрямые оральные антикоагулянтыReferencesAgnelli G., Verso M. Management of venous thromboembolism in patients with cancer. Journal of thrombosis and Haemostasis, 2011, V. 9 (Suppl 1): 316–324.Agnelli G., Verso M. Management of venous thromboembolism in patients with cancer. Journal of thrombosis and Haemostasis, 2011, V. 9 (Suppl 1): 316–324.Barsam S.J., Patel, R., Arya. Anticoagulation for prevention and treatment of cancer-related venous thromboembolism. British J. of Haematology, 2013, V. 161, Iss. 6: 764–777.Barsam S.J., Patel, R., Arya. Anticoagulation for prevention and treatment of cancer-related venous thromboembolism. British J. of Haematology, 2013, V. 161, Iss. 6: 764–777.Robin P., Carrier M. Revisiting occult cancer screening in patients with unprovoked venous thromboembolism. Thrombosis Research, 2018, V. 164 (Suppl. 1): S7–S11.Robin P., Carrier M. Revisiting occult cancer screening in patients with unprovoked venous thromboembolism. Thrombosis Research, 2018, V. 164 (Suppl. 1): S7–S11.Magnus N., D’Asti E., Meehan B., et al. Oncogenes and the coagulation system – forses that modulate dormant and aggressive states in cancer. Thrombosis Research., 2014, V. 133 (Suppl. 2): S1–S9.Magnus N., D’Asti E., Meehan B., et al. Oncogenes and the coagulation system – forses that modulate dormant and aggressive states in cancer. Thrombosis Research., 2014, V. 133 (Suppl. 2): S1–S9.Falanga A., Marchetti M. Hemostatic biomarkers in cancer progression. Thrombosis Research, 2018, V. 164 (Suppl. 1): .S54–S61.Falanga A., Marchetti M. Hemostatic biomarkers in cancer progression. Thrombosis Research, 2018, V. 164 (Suppl. 1): .S54–S61.Cedervall J., Hamidi A., Olsson A-K. Platelets, NETs and cancer. Thrombosis Research, 2018, V. 164 (Suppl. 1): S48–S52.Cedervall J., Hamidi A., Olsson A-K. Platelets, NETs and cancer. Thrombosis Research, 2018, V. 164 (Suppl. 1): S48–S52.Ten C.H., Falanga A. Overview of the postulated mechanisms linking cancer and thrombosis. Pathophysiol. Haemost. Thromb, 2007, V. 36: 122–130.Ten C.H., Falanga A. Overview of the postulated mechanisms linking cancer and thrombosis. Pathophysiol. Haemost. Thromb, 2007, V. 36: 122–130.Agnelii G., Verso M. Thromboprophylaxis during chemotherapy in patients with advanced cancer. Thrombosis Research, 2010, V. 125 (Suppl. 2): S17–S20.Agnelii G., Verso M. Thromboprophylaxis during chemotherapy in patients with advanced cancer. Thrombosis Research, 2010, V. 125 (Suppl. 2): S17–S20.Сомонова О. В., Маджуга А. В., Елизарова А. Л., Зубрихина Г. Н. Тромботические осложнения и их профилактика в онкологии // Новые возможности лекарственного лечения онкологических больных. Материалы школы по онкологии (химиотерапия опухолей). XIV Российский Национальный конгресс «Человек и лекарство». – М. – 2007. – С. 135–137.Сомонова О. В., Маджуга А. В., Елизарова А. Л., Зубрихина Г. Н. Тромботические осложнения и их профилактика в онкологии // Новые возможности лекарственного лечения онкологических больных. Материалы школы по онкологии (химиотерапия опухолей). XIV Российский Национальный конгресс «Человек и лекарство». – М. – 2007. – С. 135–137.Weitz J.I. Potential of new anticoagulsnts in patients with cancer. Thrombosis Research, 2010, V. 125 (Suppl 2): S30–S35.Weitz J.I. Potential of new anticoagulsnts in patients with cancer. Thrombosis Research, 2010, V. 125 (Suppl 2): S30–S35.Levine M.N., Lee A.Y., Kakkar A.K Thrombosis and cancer. American Society of Clinical Oncology, 41 Annual Meeting, 2005: 748–577.Levine M.N., Lee A.Y., Kakkar A.K Thrombosis and cancer. American Society of Clinical Oncology, 41 Annual Meeting, 2005: 748–577.Lee A.Y. The roles of anticoagulants in patients with cancer. Thromb Res, 2010, V. 125 (Suppl. 2): S8–S11.Lee A.Y. The roles of anticoagulants in patients with cancer. Thromb Res, 2010, V. 125 (Suppl. 2): S8–S11.Watson H.G., Keeling D.M., Laffan M. et al. On behalf of British Committee for Standarts in Haemotology. Guideline on aspects of cancer-related venous thrombosis // Brit. J. Haematol. – 2015. – Vol. 170. – P. 640–648.Watson H.G., Keeling D.M., Laffan M. et al. On behalf of British Committee for Standarts in Haemotology. Guideline on aspects of cancer-related venous thrombosis // Brit. J. Haematol. – 2015. – Vol. 170. – P. 640–648.Khorana A., Carrier M., Garcia D., Lee A. Y. Guidance for the prevention and treatment of cancer-associated venous thromboembolism // J. Thromb. Thrombolysis. – 2016. – Vol. 41. – P. 81–91.Khorana A., Carrier M., Garcia D., Lee A. Y. Guidance for the prevention and treatment of cancer-associated venous thromboembolism // J. Thromb. Thrombolysis. – 2016. – Vol. 41. – P. 81–91.Levine M.N. Prevention of thrombotic disorders in cancer patients undergoing chemotherapy // Thromb. Haemost. – 1997. – 78. – P. 133–6.Levine M.N. Prevention of thrombotic disorders in cancer patients undergoing chemotherapy // Thromb. Haemost. – 1997. – 78. – P. 133–6.Agnelii G., Verso M. Thromboprophylaxis during chemotherapy in patients with advanced cancer // Thrombosis Research. 2010. – V. 125 (Suppl. 2). – P. S17–S20.Agnelii G., Verso M. Thromboprophylaxis during chemotherapy in patients with advanced cancer // Thrombosis Research. 2010. – V. 125 (Suppl. 2). – P. S17–S20.Gran O.V., Braekhan S.K., Hansen J.B. Protrombotic genotypes and risk of venous thromboembolism in cancer // Thrombosis Research. – 2018. – Vol. 164. – P. 12–18.Gran O.V., Braekhan S.K., Hansen J.B. Protrombotic genotypes and risk of venous thromboembolism in cancer // Thrombosis Research. – 2018. – Vol. 164. – P. 12–18.Timp J.F., Braekhan S.K., Versteeg H.H., Cannegieter S.C. Epidemiology of cancer-associated venous thrombosis // Blood. – 2013. – Vol. 122. – P. 1712–1723.Timp J.F., Braekhan S.K., Versteeg H.H., Cannegieter S.C. Epidemiology of cancer-associated venous thrombosis // Blood. – 2013. – Vol. 122. – P. 1712–1723.Kuderer N.M., Lyman G.H. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer // Thrombosis Research. – 2014. – Vol. 133. – P. 122–127.Kuderer N.M., Lyman G.H. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer // Thrombosis Research. – 2014. – Vol. 133. – P. 122–127.Lyman G.H., Bohlke K., Khorana A.A. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical Practice Guideline Update 2014 // J. Clin. Oncol. – 2015. – 33. – Р. 654–656.Lyman G.H., Bohlke K., Khorana A.A. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical Practice Guideline Update 2014 // J. Clin. Oncol. – 2015. – 33. – Р. 654–656.Mandala M. Management of venous thromboembolism in cancer patients. ESMO Clinical Practice Guidelines // Ann. Oncol. – 2011. Vol. 22. – P. 82–85.Mandala M. Management of venous thromboembolism in cancer patients. ESMO Clinical Practice Guidelines // Ann. Oncol. – 2011. Vol. 22. – P. 82–85.Lee A.Y. The roles of anticoagulants in patients with cancer // Thromb Res. – 2010. – V. 125 (Suppl. 2). – P. S8–S11.Lee A.Y. The roles of anticoagulants in patients with cancer // Thromb Res. – 2010. – V. 125 (Suppl. 2). – P. S8–S11.Agnelii G., Gussoni G., Bianchini C. et. al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomized, placebo-controlled, double-blind study // Lancet. – 2009. – 10. – 943–9.Agnelii G., Gussoni G., Bianchini C. et. al. Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomized, placebo-controlled, double-blind study // Lancet. – 2009. – 10. – 943–9.Khorana A, Francis C. Risk prediction of cancer--associated thrombosis: appraising the first decade and developing the future // Thrombosis Research. – 2018. – Vol. 164. – P. 70–76.Khorana A, Francis C. Risk prediction of cancer--associated thrombosis: appraising the first decade and developing the future // Thrombosis Research. – 2018. – Vol. 164. – P. 70–76.Kimpton M., Wells Ph., Carrier M. Apixaban for the prevention of venous thromboembolism in high-risk ambulatory cancer patients receiving chemotherapy: rational and design of the Avert trial // Thrombosis Research. – 2018. – Vol. 164. –P. 24–28.Kimpton M., Wells Ph., Carrier M. Apixaban for the prevention of venous thromboembolism in high-risk ambulatory cancer patients receiving chemotherapy: rational and design of the Avert trial // Thrombosis Research. – 2018. – Vol. 164. –P. 24–28.Kuderer N., Lyman G. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer // Thrombosis Research. – 2014. – V. 133 (Suppl. 2). – S122–S127.Kuderer N., Lyman G. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer // Thrombosis Research. – 2014. – V. 133 (Suppl. 2). – S122–S127.Сомонова О.В., Антух Э.А., Елизарова А.Л. и др. Практические рекомендации по профилактике и лечению тромбоэмболических осложнений у онкологических больных. Злокачественные опухоли. Практические рекомендации по лекарственному лечению злокачественных опухолей* Практические рекомендации по поддерживающей терапии в онкологии» (RUSSCO)/ под редакцией В.М.Моисеенко // 2017. – Т. 7. – С. 553–558.Сомонова О.В., Антух Э.А., Елизарова А.Л. и др. Практические рекомендации по профилактике и лечению тромбоэмболических осложнений у онкологических больных. Злокачественные опухоли. Практические рекомендации по лекарственному лечению злокачественных опухолей* Практические рекомендации по поддерживающей терапии в онкологии» (RUSSCO)/ под редакцией В.М.Моисеенко // 2017. – Т. 7. – С. 553–558.Kearon C., Akl E.A., Ornelas J. et al. Antithrombotic therapy for VTE disease // Chest. – 2016. – 149 (2) – P. 315–352.Kearon C., Akl E.A., Ornelas J. et al. Antithrombotic therapy for VTE disease // Chest. – 2016. – 149 (2) – P. 315–352.Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО) //Флебология. – 2015. –Т. 9. – № 4. – выпуск 2. – С. 2–52.Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО) //Флебология. – 2015. –Т. 9. – № 4. – выпуск 2. – С. 2–52.Guyatt G.H., Akl E.A., Growther M. et al. Executive Summary. Antithrombotic therapy and Prevention of Thrombosis, 9th ed: ACCP evidence-based clinical practice guidelines // Chest. – 2012. – V. 141(2). – (Suppl). – P. 7S–47S.Guyatt G.H., Akl E.A., Growther M. et al. Executive Summary. Antithrombotic therapy and Prevention of Thrombosis, 9th ed: ACCP evidence-based clinical practice guidelines // Chest. – 2012. – V. 141(2). – (Suppl). – P. 7S–47S.Watson H.G., Keeling D.M., Laffan M. et al. Guedeline on aspects of cancer-related venous thrombosis // British J. of Haematology. – 2015. – V. 170. – Iss. 5. – P. 640–648.Watson H.G., Keeling D.M., Laffan M. et al. Guedeline on aspects of cancer-related venous thrombosis // British J. of Haematology. – 2015. – V. 170. – Iss. 5. – P. 640–648.Kyrle P.A. Predicting recurrent venous thromboembolism in cancer: is it possible? // Thrombosis Research. – 2014. –V. 133 (Suppl. 2). – S17–S22.Kyrle P.A. Predicting recurrent venous thromboembolism in cancer: is it possible? // Thrombosis Research. – 2014. –V. 133 (Suppl. 2). – S17–S22.Kearon C., Akl E.A. Ornelas J et al. Antithrombotic therapy for VTE disease. // Chest. – 2016. – V. 149 (2). – P. 315–352.Kearon C., Akl E.A. Ornelas J et al. Antithrombotic therapy for VTE disease. // Chest. – 2016. – V. 149 (2). – P. 315–352.Lee A.Y. Overview of VTE treatment in cancer according to clinical guidelines // Thrombosis Research. – 2018. – V. 164 (Suppl. 1) – S162–S167.Lee A.Y. Overview of VTE treatment in cancer according to clinical guidelines // Thrombosis Research. – 2018. – V. 164 (Suppl. 1) – S162–S167.Verso M., Franco L., Giustozzi M. et al. Treatment of venous thromboembolism in patients with cancer: whats news from clinical trials? // Thrombosis Research. – 2018. – V. 164 (Suppl. 1) –S168–S171.Verso M., Franco L., Giustozzi M. et al. Treatment of venous thromboembolism in patients with cancer: whats news from clinical trials? // Thrombosis Research. – 2018. – V. 164 (Suppl. 1) –S168–S171.

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