rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2014-10-6-634-639rpcardio-300Research ArticleASSOCIATED PROBLEMS OF CARDIOLOGYСМЕЖНЫЕ ПРОБЛЕМЫ КАРДИОЛОГИИTHE PROBLEM OF THE USE OF NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS RECEIVING CHEMOTHERAPYПРОБЛЕМА ИСПОЛЬЗОВАНИЯ НОВЫХ ПЕРОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ У ОНКОЛОГИЧЕСКИХ ПАЦИЕНТОВ, ПОЛУЧАЮЩИХ ХИМИОТЕРАПИЮРумянцевА. А.RumyantsevA. A.

клинический ординатор отделения клинической фармакологии и химиотерапии

115478, г. Москва, Каширское шоссе, 23

Kashirskoye shosse 23, Moscow, 115478 Russia

alexeymma@gmail.comПокатаевИ. А.PokataevI. A.

к.м.н., врач-онколог того же отделения

115478, г. Москва, Каширское шоссе, 23

Kashirskoye shosse 23, Moscow, 115478 Russia

КозловаТ. В.KozlovT. V.

д.м.н., в.н.с. лаборатории проблем тромбозов, тромбофилий и патологии гемостаза научно-исследовательского центра

119991, Москва, ул. Трубецкая, 8, стр. 2

Trubetskaya ul. 8-2, Moscow, 119991 Russia

РумянцевН. А.RumyantsevN. A.

аспирант кафедра клинической фармакологии и пропедевтики внутренних болезней

119991, Москва, ул. Трубецкая, 8, стр. 2

Trubetskaya ul. 8-2, Moscow, 119991 Russia

Российский онкологический научный центр им. Н.Н. БлохинаРоссияRussian Cancer Research Center named after N.N. BlokhinRussian FederationПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation201425092015106634639Copyright © Rumyantsev A.A., Pokataev I.A., Kozlov T.V., Rumyantsev N.A., 20152015Румянцев А.А., Покатаев И.А., Козлова Т.В., Румянцев Н.А.Rumyantsev A.A., Pokataev I.A., Kozlov T.V., Rumyantsev N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/300

Despite large number of known risk factors of venous thromboembolism (VTE) in cancer patients existing prediction models do not allow definite identification of cancer patients that have indications for anticoagulant prevention. Besides, heparin and warfarin use for VTE prevention in cancer is accompanied by some problems. New oral anticoagulants (NOAC) are promising drugs for use in oncology practice; however their use is complicated by the lack of data on efficacy and safety in these patients, potential drug interactions and the possibility of unpredictable changes in effect during chemotherapy. Widespread use of NOAC for the prevention and treatment of tumor-associated VTE prior to phase III trials is not recommended. However, the criteria for selection of patients for whom the study of the efficacy and safety of NOAC is a priority can now be developed.

Несмотря на большое количество известных факторов риска развития венозного тромбоэмболизма (ВТЭ) у онкологических пациентов, существующие прогностические модели не позволяют однозначно выделять тех, кому показано проведение антикоагулянтной профилактики. Кроме того, применение гепаринов и варфарина с целью профилактики ВТЭ в онкологии сопровождается рядом проблем. Новые оральные антикоагулянты (НОАК) являются перспективными препаратами для применения в онкологической практике, однако их применение осложняется отсутствием данных по эффективности и безопасности у таких пациентов, потенциальными лекарственными взаимодействиями и возможностью непредсказуемого изменения эффекта на фоне химиотерапии. Широкое применение НОАК с целью профилактики и лечения опухоль-ассоциированного ВТЭ до проведения исследований III фазы не рекомендуется, однако уже сейчас возможно сформировать критерии отбора пациентов, для которых изучение эффективности и безопасности НОАК является приоритетной задачей.

тромбозвенозный тромбоэмболизмзлокачественные новообразованияонкологияновые оральные антикоагулянтыthrombosisvenous thromboembolismcanceroncologynew oral anticoagulantsReferencesNCCN Clinical Practice Guidelines in Oncology. Cancer-associated Venous Thromboembolic disease. VersionNCCN Clinical Practice Guidelines in Oncology. Cancer-associated Venous Thromboembolic disease. Version2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. Accessed by 06.12.20142014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. Accessed by 06.12.2014Khorana AA, Kuderer N, Culakova E, et al. Development and validation of a predictive model for chemotherapyassociated thrombosis. Blood 2008;111: 4902-7.Khorana AA, Kuderer N, Culakova E, et al. Development and validation of a predictive model for chemotherapyassociated thrombosis. Blood 2008;111: 4902-7.Gary T, Belaj K, Steidl K, et al. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival. Br J Cancer 2012;107:1244-8.Gary T, Belaj K, Steidl K, et al. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival. Br J Cancer 2012;107:1244-8.Palumbo JS, Talmage KE, Massari JV et al. Tumor cell-associated tissue factor and circulating hemostatic factors cooperate to increase metastatic potential through natural killer cell-dependent and-independent mechanisms. Blood 2007;110:133-141.Palumbo JS, Talmage KE, Massari JV et al. Tumor cell-associated tissue factor and circulating hemostatic factors cooperate to increase metastatic potential through natural killer cell-dependent and-independent mechanisms. Blood 2007;110:133-141.Monreal M, Falga C, Valdes M et al. Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: findings from the RIETE registry. J Thromb Haemost 2006;4: 1950-6.Monreal M, Falga C, Valdes M et al. Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: findings from the RIETE registry. J Thromb Haemost 2006;4: 1950-6.Khorana AA, Connolly GC. Assessing Risk of Venous Thromboembolism in the Patient With Cancer. J Clin Oncol 2009;27:4839-47.Khorana AA, Connolly GC. Assessing Risk of Venous Thromboembolism in the Patient With Cancer. J Clin Oncol 2009;27:4839-47.Konigsbrugge O, Pabinger I, Ay C. Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Study (CATS). Thrombosis Research 2014;133:39-43.Konigsbrugge O, Pabinger I, Ay C. Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Study (CATS). Thrombosis Research 2014;133:39-43.Roach REJ, Lijfering WM, van Hylckama VA et al. The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors. Blood 2013;122: 4264-9.Roach REJ, Lijfering WM, van Hylckama VA et al. The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors. Blood 2013;122: 4264-9.Riedl J, Kaider A, Reitter E-M et al. Association of mean platelet volume with risk of venous thromboembolism and mortality in patients with cancer: results from the Vienna Cancer and Thrombosis Study (CATS). Thromb Haemost 2013;111:670-8.Riedl J, Kaider A, Reitter E-M et al. Association of mean platelet volume with risk of venous thromboembolism and mortality in patients with cancer: results from the Vienna Cancer and Thrombosis Study (CATS). Thromb Haemost 2013;111:670-8.Thaler J, Ay C, Pabinger I. Venous thromboembolism in cancer patients - risk scores and recent randomized controlled trials. Thromb Haemost 2012;108:1042-8.Thaler J, Ay C, Pabinger I. Venous thromboembolism in cancer patients - risk scores and recent randomized controlled trials. Thromb Haemost 2012;108:1042-8.Short N, Connors J. New Oral Anticoagulants and the Cancer Patient. The Oncologist 2014; 19: 82-93.Short N, Connors J. New Oral Anticoagulants and the Cancer Patient. The Oncologist 2014; 19: 82-93.Spinler SA. New Concepts in Heparin-Induced Thrombocytopenia: Diagnosis and Management. J Thromb Thrombolysis 2006;21(1):17-21.Spinler SA. New Concepts in Heparin-Induced Thrombocytopenia: Diagnosis and Management. J Thromb Thrombolysis 2006;21(1):17-21.Levine MN, Gu C, Liebman HA, et al. A randomized phase II trial of apixaban for the prevention of thromboembolism in patients with metastatic cancer. J Thromb Haemost 2012;10(5):807-14Levine MN, Gu C, Liebman HA, et al. A randomized phase II trial of apixaban for the prevention of thromboembolism in patients with metastatic cancer. J Thromb Haemost 2012;10(5):807-14Apixaban for the Prevention of Venous Thromboembolism in Cancer Patients (AVERT). Available at: http://clinicaltrials.gov/ct2/show/NCT02048865. Accessed by 06.12.2014Apixaban for the Prevention of Venous Thromboembolism in Cancer Patients (AVERT). Available at: http://clinicaltrials.gov/ct2/show/NCT02048865. Accessed by 06.12.2014Gerotziafas GT, Mahe I, Elalamy I. New orally active anticoagulants agents for the prevention and treatment of venous thromboembolism in cancer patients. Ther Clin Risk Manag 2014;10: 423-36.Gerotziafas GT, Mahe I, Elalamy I. New orally active anticoagulants agents for the prevention and treatment of venous thromboembolism in cancer patients. Ther Clin Risk Manag 2014;10: 423-36.

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