Update: Antikoagulationstherapie bei tumorassoziierter venöser Thromboembolie

Bei Tumorpatienten sind symptomatische und sogenannte inzidentelle tiefe Venenthrombosen und Lungenembolien häufig. Es wird eine prolongierte, regelhaft über 3 Monate hinausgehende Antikoagulation empfohlen, wobei die therapiebedingte Zunahme eines bei Malignompatienten vorbestehend erhöhten Blutungsrisikos besonderer Berücksichtigung bedarf. Neben den parenteralen niedermolekularen Heparinen stehen orale Faktor-Xa-Inhibitoren mit hohem Evidenzniveau gleichwertig für die Initialtherapie und Sekundärprophylaxe von Tumorpatienten zur Verfügung. Eine präferenzielle Empfehlung über die Art, Dauer und Intensität einer prolongierten Antikoagulation ist evidenzbasiert nicht zu geben. Sie sollte neben den individuellen und tumorentitätsspezifischen Risiken für Blutungen und Rezidivthrombosen auch Präparate-spezifische Charakteristika, Therapiekosten und die Patientenpräferenz einbeziehen.

Abstract

Symptomatic as well as so-called incidental deep venous thromboses and pulmonary embolisms are frequent complications in cancer patients. A prolonged anticoagulation, regularly for more than three months, considering the treatment-associated enhancement of a preexisting increased cancer-associated bleeding risk, is recommended. In addition to parenteral low molecular weight heparins oral factor Xa inhibitors became an equally good, high-level evidence-based option for initial treatment and secondary prophylaxis of cancer patients. An evidence-based preferential recommendation of kind, duration and intensity of anticoagulation cannot be given. It needs to consider individual and the cancer type associated risks of bleeding and recurrent thromboembolism, as well as characteristics of anticoagulant drugs, treatment costs and patient’s preference.

Schlüsselwörter

Tumor - venöse Thromboembolie - Antikoagulation - niedermolekulare Heparine - Faktor-Xa-Inhibitoren

Keywords

cancer - venous thromboembolism - anticoagulation - low molecular weight heparins - factor Xa inhibitors

Publikationsverlauf

Artikel online veröffentlicht:
02. April 2025

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