The Risk Assessment Of Cancer-associated Thrombosis And The Clinical Significance Of Early Intervention In Hypercoagulability

Objective: Tumor associated thrombosis is an important complication of cancer patients, the incidence rate was 4%~20%, which is one of the leading causes of death in patients with cancer. In recent years, several large studies show that effective scoring model?biochemical index and preventive measures of anticoagulation can largely prevent thromboembolic events. Which patients require preventive anticoagulant therapy? How to carry out the anticoagulant therapy? The two problems in the current "accurate" background have been referred to a more important position.1 In this study, inpatients with cancer were grouped according to the Khorana risk score model, the incidence of thrombosis was observed, and the clinical applicability of the Khorana risk score model was evaluated.2 To study the clinical significance of early intervention in the treatment of cancer patients with chemotherapy.Methods:1 According to the Khorana risk assessment model, patients from January 2013 to December 2015 were divided into low risk, moderate risk and high risk groups, observe the difference of blood coagulation function, Ddimer.2 The patients who met the inclusion criteria were categorized into the thrombus group and the non-thrombus group, analyze the consistency of coagulation function and ultrasound examination results. Patients in thrombus group and high subgroup of non-thrombus were given low molecular weight heparin(LMWH) with therapeutic does and prophylactic dose separately on the basis of NCCN and CSCO guideline. The patients of low and medium risk subgroups in non-thrombus group were randomly divided into experimental group and control group according to receiving preventive anticoagulant therapy or not, the primary endpoint was anticoagulant efficiency, the secondary endpoints were 3 years of cumulative incidence of thrombosis, the incidence of adverse events, overall survival rate(OS), progression-free survival(PFS).3 Analyze the changes of coagulation and D-dimer every 25 days after anticoagulation therapy of the patients in experimental group, which were included by the low and medium risk subgroups in non-thrombus group.4 The clinical data of thrombus and non-thrombus group was collected retrospectively, by univariate and multivariate analysis to explore the impact of risk factors for thrombosis.Prophylactic anticoagulation therapy in patients who did not have VTE included low molecular weight heparin calcium 4100 IU, subcutaneous injection of 1 times/ day or low molecular weight heparin sodium injection 5000 IU, subcutaneous injection 1 times / day. VTE patients treatments include oxygen, brake, raise the affected limb 15-30°, and give low molecular weight heparin calcium 4100 IU, subcutaneous injection of 2 times/ day or low molecular weight heparin sodium injection 5000 IU, subcutaneous injection 2 times / day treatment at the same time.The main mode of follow-up included the in-patient, out-patient and phone. All patients were followed up until December 31 th, 2015. Establishing a database of all clinical data and analyzing date by the application of SPSS 21.0 statistical software. Count data using ?~2 test, non-parametric test is used to satisfy the non normality of the data. Analysis of the consistency between coagulation function and ultrasound examination results by Kappa test. ROC curve was used to the evaluation of diagnostic value; draw survival curves using the Kaplan Meier method; using a logistic regression model was used for univariate, multivariate analysis, P<0.05 were considered to be statistically significant.Results:1 All patients were grouped according to the Khorana risk assessment model, PT?INR?FIB index had a statistically significant difference(P<0.05). PLT?APTT?TT?D-dimers had no significant difference(P>0.05).2 Diagnosis is by vein Doppler ultrasound, three groups of the incidence of thrombosis were: 6.98% and 26.9%, 46.15%, results showed a poor consistency of the coagulation function and ultrasound examination. For patients in the high-risk group, model of sensitivity, specificity, positive predictive value, negative predictive value 18.2%, 95.1%, 46.2%, 83.5% respectively. The area under the ROC curve was 0.72, with statistical significance(P < 0.05), the diagnostic value was medium.3 For low risk subgroup of patients with non-thrombosis group, experimental group and control group anticoagulant efficiency were 93.55%?88.89%, having no statistical significance(P>0.05), for medium risk subgroup of patients, experimental group and control group anticoagulant efficiency were 86.67%?80.00%, having no statistical significance(P>0.05).4 Low and medium risk subgroup of patients in the experimental group and control group, the 3 years cumulative incidence of VTE was 6.45%, 11.11%, 13.33%, 20%, respectively, no statistical significance(P>0.05). The incidence of adverse events were 7.01%, 2.24%, no statistical significance(P>0.05).5 The OS?PFS in the experimental group and control group had no statistical significant(P >0.05).6 Detect the coagulation function ? D-dimer every 25 days in the experimental group of the thrombus group patients, compare the dynamic changes before and after prophylactic anticoagulation therapy. Result displayed patients at different time points had different hematologic testing results. There had statistical significances of TT changes in low risk group, FIB changes in medium risk group after 1 cycle of anticoagulation(P<0.05). PLT?PT changes had statistical significances in low risk group after 3 cycles(P<0.05), PT?D-D changes had statistical significances in low risk group after 4 cycles(P<0.05).7 For patients with thrombosis, univariate analysis showed that tumor stage, accompanied with high risk factors which leaded to the recurrence and metastasis of primary tumor, with effusion, rh G CSF treatment, hormone treatment, had a history of embolism and other operation history, count of hemoglobin, D-dimer had a relationship with thrombosis, and had a statistical significance(P<0.05).8 Multivariate analysis which were selected with P<0.05 by single factor analysis showed that: accompanied with high risk factors which leaded to the recurrence and metastasis of primary tumor, with effusion entered into regression equation finally, the two indexs were the independent factors affecting thrombosis.Conclusions:1 For patients with chemotherapy for malignant tumor, we can make a admission according to the Khorana risk assessment model, this model has a high specificity for diagnostic value, the overall diagnostic value is medium.2 For inpatients according to the model, we suggest that low and medium risk patients are encouraged to reduce the probability of occurrence of thrombosis not by drug prevention, however, evaluating the risk of thromboembolism regularly, dynamic monitoring of blood coagulation are needed, timely confirmed by image examination, so as to adjust the treatment plan.3 Not only by clinical symptoms or Khorana risk assessment model to make the diagnosis of DVT, blood and venous ultrasonography can improve the positive rate of venous thrombosis for the patients which are clinical suspicion or high risk score. Clinician should follow the principle that "dynamic monitoring, whole management" to the hospitalized patients, through intervention treatment strategy of flexible adjustment to reduce the thrombosis prevalence and mortality.