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Trombose Kanker Antistolling

Trombose Kanker Antistolling. Hans-Martin Otten , Slotervaart Ziekenhuis/AMC NVMO, Amersfoort 9 mei 2003. Arteriële Thrombose Veneuze Thrombose Antistolling. Arteri ële trombose. Lage frequentie. Veneuze trombose paraneoplastisch. 1823 Bouillaud Archives générales de médicine.

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Trombose Kanker Antistolling

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  1. Trombose KankerAntistolling Hans-Martin Otten, Slotervaart Ziekenhuis/AMC NVMO, Amersfoort 9 mei 2003

  2. Arteriële Thrombose Veneuze Thrombose Antistolling

  3. Arteriële trombose Lage frequentie

  4. Veneuze tromboseparaneoplastisch 1823 Bouillaud Archives générales de médicine

  5. Maligniteit Incidentie van veneuze tromboembolie bij kanker ?

  6. Verstorende factoren • Immobiliteit • Maligniteit type/stadium • Chirurgie • Centraal veneuze catheter • Chemo / Hormonale therapie

  7. Immobiliteit ?

  8. Maligniteit Type Hematologisch Solide Baron JA, et al. Lancet. 1998;351:1077-80 Sørensen HT, et al. N Engl J Med. 1998;338:1169-73 Nordström M, et al. BMJ. 1994;308:891-4.

  9. Maligniteit Stadium I IV

  10. Chirurgie Afhankelijk van soort operatie

  11. Post chirurgie Ovarium1 6% Cervix/endometrium2 20% Borst3 3% 1Heilmann et al. Clin Appl Thromb Hemost 1998 2Clahsen et al. J Clin Oncol 1994 2von Tempelhoff et al. Clin Appl Thromb Hemost 1996 3Heilmann et al. Geburtsh und Frauenheilk 1997

  12. Post chirurgie Alle VTE 20-25% Symptomatische VTE 6-9% Met profylaxe 1-2% Clagett, Reisch. Ann Surg. 1988;208:227-40. Collins, Scrimgeour, Yususf, et al. N Engl J Med. 1988;318:1162-73. Kakkar, Djazaeri, Fok, et al. Br Med J. 1982;284:375-9. Nurmohamed, Rosendaal, Büller et al. Lancet 1992;340:152-6.

  13. Profylaxe na chirurgie 1 week 4 weken 4 weken Totaal VTE % 12.0 4.8 DVT/PE 2.4 0.6 3 maanden Totaal VTE % 13.8 5.5 DVT/PE 3.6 1.2 Symptomatisch ? ? N Engl J Med, 2002;346:975-80

  14. Profylaxe na chirurgie Soort LMWH Elastische kousen?

  15. Chemotherapie Vergelijkend onderzoek Andere risicofactoren Onderrapportage

  16. Chemotherapie Borst kanker stadium I-II 0.5% + chemo 2.0% Hormonale behandeling st. I-II 1.0% + chemo 4% St. IV + chemo 5-8.% Fisher B, NEJM 1989 320:479-84, Clahsen PC, JCO 1994 12:1266-71 Levine MN, NEJM 1988 318:404-7, Tempelhoff GF von, JCO 1996 14:2560-8 Pritchard KI, JCO 1996 14:2731-7

  17. Chemotherapie Multipel Myeloma Thalidomide 1 2% Thal/Dexa/(Cis/Cyclo/Etop/)Doxo 2,3 14% Thal/Dexa/Cis/Cyclo/Etop 4 2,6% Thal/Dexa/Cis/Cyclo/Etop/Doxo 4 11,6% 1 Barlogie B, Blood 2001, 98:492-4 2 Zangari M, Blood 2001, 98:1614-5 3 Osman K, NEJM 2001, 344: 1951-2 4 Zangari M, Blood 2002, 100:1168-71

  18. Profylaxe tijdens chemotherapie Warfarine (INR 1.5) Placebo pts 152 159 VTE 1 7 Levine M. Double-blind randomised trial of very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer. Lancet 1994;343:886-9.

  19. Behandeling LMWH Warfarine

  20. Behandelingbloedingsrisico no. +/- carc.Risk ratio Gitter153/2084.3 Hutten2264/10396.3 Landefeld334/3775.1 Palareti4102/7905.2 Prandoni558/297 2.2 1 Mayo Clin Proc 1995; 70: 725-33; 2 J Clin Oncol 2000; 18: 3078-83; 3 Am J Med 1987; 82: 703-13; 4 Thromb Haemost 2000; 84: 805-10; 5 Blood. 2002;100:3484-3488

  21. BehandelingRecidief VTE no. +/- carc.Risk ratio Gitter153/2083.7 Hutten2264/10393.0 Monreal384/35017.2 Prandoni458/297 3.2 1 Mayo Clin Proc 1995; 70: 725-33; 2 J Clin Oncol 2000; 18: 3078-83; 3 Haemostasis 1998; 28: 236-43; 4 Blood. 2002;100:3484-3488

  22. Behandeling 3 maanden LMWH Warfarine 71 75 Bloeding % 7 16 Fataal 0 8 Recidief VTE % 5 4 Dood % 31 39 Meyer. Arch Int Med 2002;162:1729-35

  23. Conclusie VTE frequent tijdens behandeling Chirurgie Chemotherapie Profylaxe effectief bij chirurgie, chemotherapie ? Behandeling met LMWH: minder bloedingsrisico

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