A Research Of Anticoagulant Therapy Combined With Chemotherapy In Patients With Advanced Cancer

Objective The purpose of this study was to explore the role and significance of prophylactic anticoagulation combined with chemotherapy in the prevention of venous thrombosis,total survival time(OS)and progression free survival time(PFS)in patients with advanced cancer,and to evaluate the safety of prophylactic anticoagulation.Methods 177 patients with primary stage Ⅲ-Ⅳ malignant solid tumors were divided into two groups: preventive anticoagulant group(standard chemotherapy + low molecular weight heparin)and non anticoagulant group(standard chemotherapy alone).97 patients in the preventive anticoagulant group,80 patients in the non anticoagulant group,in the preventive anticoagulation group,"chemotherapy + LMWH 0.3ml,qd" was used,while in the non anticoagulation group,chemotherapy alone was used.By analyzing the general situation of patients,the related situation of thrombosis,the change of coagulation index,total survival time,progression free survival time and bleeding event after 4-6 course chemotherapy in the two groups,the study explored the influence of preventive anticoagulation therapy combined with chemotherapy on patients with advanced tumor,and evaluated the related risk of blood.Results According to the Khorana scoring model,the incidence of venous thrombosis was 4.0%,4.5% and 0% respectively in the low,medium and high risk groups.There was no significant difference between the two groups.Among 177 patients,there were 11 cases of venous thrombosis,including 10 cases of simple deep vein thrombosis and 1 case of pulmonary embolism.The number of patients with venous thrombosis was 2,0,4,3 and 2,respectively,1 month,1-3 months,4-6 months,7-12 months and more than 12 months from the diagnosis of malignant tumor events.Thrombus formation was not related to gender,age,basic disease,TMN stage,PS score,coagulation function before treatment and whether patients received radiotherapy,targeted treatment,blood transfusion and deep vein catheterization.Among the patients with venous thrombosis,the incidence of the preventive anticoagulant group was 4.1%,and that of the non anticoagulant group was 8.8%,but the difference was not statistically significant;there was no significant difference in INR and fibrinogen(Fbg)between the two groups before and after chemotherapy;the incidence of the D-Dimer(ng /ml)preventive anticoagulant group after chemotherapy was1554.44± 1591.70,which was significantly lower than that before chemotherapy;the incidence of the non anticoagulant group was 2758.26±4803.99,which was significantly higher than that before chemotherapy,p=0.034,p<0.05,the difference was statistically significant.Preventive anticoagulation improved hypercoagulability.There was no significant difference in OS and PFS between the two groups.Single factor and multivariate Cox regression analysis showed that Khorana score,stage,PS score,blood transfusion products and D-dimer before treatment were the common independent risk factors for OS and PFS.No adverse events related to anticoagulant use were found in all patients in the preventive anticoagulant group.Conclusions 1.The majority of tumor patients with thrombus occurred within one year after diagnosis,the peak period was 4-6 months.The common thrombus was deep vein thrombus of limbs.2.Prophylactic anticoagulant therapy has a positive effect on improving hypercoagulability of patients with malignant tumors.3.Prophylactic anticoagulation has good safety in patients with malignant tumors,does not affect coagulation function,and has no major bleeding events.4.Khorana score,blood transfusion products and D-dimer before treatment are independent risk factors for OS and PFS in patients with advanced cancer.These three factors are related to hypercoagulability of blood.Therefore,we must pay attention to the prevention of tumor related VTE.