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Advisor(s)
Abstract(s)
A associação entre cancro e eventos tromboembólicos é reconhecida há mais de 150 anos,
sendo vários os fatores que contribuem para esta relação, nomeadamente os fatores de
coagulação, o crescimento e a invasão tumorais, a presença de metástases e a agressão
cirúrgica.
O reconhecimento desta associação e a implementação de protocolos de profilaxia têm
sido de crucial importância para a redução da mortalidade relacionada ao
tromboembolismo venoso. Os esquemas de profilaxia, nos doentes oncológicos, baseiamse na utilização de heparina de baixo peso molecular ou de heparina não fracionada. A
heparina de baixo peso molecular, por sua vez, está preconizada, tanto no tratamento
inicial como prolongado. No entanto, os novos anticoagulantes orais parecem ser uma
nova opção para o tratamento prolongado do tromboembolismo venoso neste subtipo de
doentes, estando já contemplados nas guidelines mais recentes. Os novos anticoagulantes
orais apresentam vantagens quer em relação à heparina de baixo peso molecular, pois são
administrados por via oral, quer aos antagonistas da vitamina K, uma vez que não carecem
de monitorização e parecem estar associados a menor taxa de recorrência de eventos
tromboembólicos.
Com esta dissertação, pretende-se uma revisão da literatura sobre esta temática,
nomeadamente sobre a fisiopatologia, os modelos de avaliação de risco e protocolos de
profilaxia e tratamento.
The association between cancer and thromboembolic events has been recognized for over 150 years and there are several factors that contribute to this association, such as clotting factors, tumor growth and invasion, the presence of metastasis, as well as the surgical aggression itself. Recognition of this association and the implementation of prophylaxis protocols have been of crucial importance for reducing venous thromboembolism associated mortality. Prophylaxis is based on the use of low molecular weight heparin or unfractionated heparin and, both initial and prolonged treatment is based on the use of low molecular weight heparin. However, new oral anticoagulants appear to be an alternative strategy for prolonged treatment of cancer associated venous thromboembolism. Some recent guidelines already recomend the use of new oral anticoagulants. They have an advantage over low molecular weight heparin because they are given orally. When compared to vitamin K antagonists, the new oral anticoagulants seem to be associated with a lower recurrence rate of venous thromboembolism and do not require regular monitoring. This dissertation intends to review the literature on this subject, namely the pathophysiology, risk assessment models, prophylaxis and treatment protocols.
The association between cancer and thromboembolic events has been recognized for over 150 years and there are several factors that contribute to this association, such as clotting factors, tumor growth and invasion, the presence of metastasis, as well as the surgical aggression itself. Recognition of this association and the implementation of prophylaxis protocols have been of crucial importance for reducing venous thromboembolism associated mortality. Prophylaxis is based on the use of low molecular weight heparin or unfractionated heparin and, both initial and prolonged treatment is based on the use of low molecular weight heparin. However, new oral anticoagulants appear to be an alternative strategy for prolonged treatment of cancer associated venous thromboembolism. Some recent guidelines already recomend the use of new oral anticoagulants. They have an advantage over low molecular weight heparin because they are given orally. When compared to vitamin K antagonists, the new oral anticoagulants seem to be associated with a lower recurrence rate of venous thromboembolism and do not require regular monitoring. This dissertation intends to review the literature on this subject, namely the pathophysiology, risk assessment models, prophylaxis and treatment protocols.
Description
Keywords
Cancro Cirurgia Oncologia Tromboembolismo Venoso