| Objectives:To select the chemotherapy which causes low risk of thrombus, and recommend to the lung cancer patient with high risk of VTE while receiving professional oncotherapy by comparing the following three lung cancer chemotherapy regimens (docetaxel combined with cisplatin, gemcitabine combined cisplatin, pemetrexed combined cisplatin). To evaluate the risk of suffering from thrombosis between non small cell lung cancer patients with initial treatment and after receiving multiple cycles of chemotherapy. Meanwhile, this study can provide antitumor professional clinical pharmacists with basis for pharmaceutical care mode and the formulation of pharmacy work path. To ensure the realization of the individualized treatment and the reduction of thrombosis while receiving professional antineoplaston by discussing the mode of the whole pharmaceutical care given by the clinical pharmacist.Methods:Collect38blood samples of the patients with non-small cell lung cancer who are in line with inclusion criteria and receive chemotherapy in Jinan Central Hospital Affiliated to Shandong University from July,2011to May,2013.(There are12patients in docetaxel combined with cisplatin group, receiving24cycles of chemotherapy; there are14patients in Gemcitabine combined cisplatin group, receiving38cycles of chemotherapy; there are12cases in Pemetrexed combined cisplatin group, receiving24cycles of chemotherapy.) Measure the routine blood, plasma D-dimer, Prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen72hours before and after chemotherapy respectively.[1] Compare the differences of the changes of fibrinogen content among these three treatment regimens before and after chemotherapy.[2] Compare the differences of the changes of the platelet count of plasma, prothrombin time, activated partial prothrombin time and thrombin time, D-dimer among these three treatment regimens as well as the rate of VTE among these three groups.[3]Compare variation of the above indicators between patients who receive initial chemotherapy and many cycles of chemotherapy as well as the risk of developing thrombosis between treatment-experienced and treatment-naive patients.Results:[1] Compared with pemetrexed combined cisplatin group, fibrinogen levels of docetaxel combined with cisplatin group increase significantly after chemotherapy with statistical significance(P<0.05).Compared with gemcitabine combined cisplatin group, chemotherapy fibrinogen content of docetaxel combined with cisplatin group increase slightly without statistical significance(P>0.05). Compared with pemetrexed combined cisplatin group, chemotherapy fibrinogen content of Gemcitabine combined cisplatin group is higher than before treatment without statistical significance(P>0.05).[2] Compared with docetaxel combined with cisplatin group, thrombin time of Gemcitabine combined cisplatin group prolong significantly after chemotherapy with statistical significance(P<0.05).The other two group do not show obvious difference. Differences of platelet count, prothrombin time, activated partial prothrombin time and the change of D-dimer among the three groups are not observed statistically before and after chemotherapy (P>0.05).[3] Compared with multiple cycles of chemotherapy patients, the variation of platelet count, prothrombin time, activated partial prothrombin time, thrombin time, fibrinogen content and the change of D-dimer of initial chemotherapy patients is not obviously different and the result has no statistical significance(P>0.05).Conclusions:[1] Compared with pemetrexed combined cisplatin, patients in docetaxel combined with cisplatin therapeutic regimen group are more likely to be led to elevated fibrinogen levels and increased risk of blood clots.[2] Compared with docetaxel combined with cisplatin group, thrombin time of gemcitabine combined cisplatin group prolongs significantly, fibrinolytic system function in the body is hyper and blood clots is at a lower risk after chemotherapy.[3] The difference of coagulation index changes between primary chemotherapy patients and multiple cycles of chemotherapy patients is not observed, so it cannot be proved that the risk of thrombus is higher at the initial stage than after many treatment cycles. |
