Neue Optionen in der Antikoagulation bei therapie -refraktärem Trousseau-Syndrom

Zusammenfassung

Was bisher bekannt ist:

Venöse Thrombembolien sind eine häufige und potenziell lebensbedrohliche Komplikati-on für Tumorpatienten, rezidivierende Thrombembolien trotz einer adäquaten Antikoagulation sind nicht ungewöhnlich. Für diese Pa-tienten gibt es bisher noch keine Therapieempfehlungen.

Was dieser Artikel vermitteln soll:

Der Gebrauch von direkten Thrombininhibitoren wie Argatroban oder Dabigatran kann eine mögliche Alternative zur Stabilisierung einer bisher unbehandelbaren Gerinnungsaktivierung darstellen, wenn eine exzessive Thrombingeneration vorhanden ist. Eine Kombinationstherapie mit Antikoagulantien unterschiedlicher Angriffspunkte im Gerinnungssystem (wie niedermolekulare Heparine oder selektive Faktor-Xa-Hemmer zusamen mit direkten Thrombininhibitoren) können bei Patienten mit rezidivierenden Thromboembo-lien eine sinnvolle Alternative über die Standardtherapie hinaus bei darstellen.

Summary

What is already known about the subject:

Venous thromboembolism is a common and potentially life-threatening complication in cancer patients and recurrent VTE despite adequate anticoagulant therapy is not unusual. However, there is no recommended treatment strategy for these patients.

What this paper adds:

The use of direct thrombin inhibitors such as argatroban or dabigatran could be a potential option to stabilize otherwise untreatable coagulation activation, if excessive thrombin generation is present. Combination therapy with differently acting anticoagulants (such as low-molecular weight heparins or selective factor Xa-inhibitors together with direct thrombin inhibitors) may be beneficial in situations of recurrent VTE despite adequate standard therapy.

Schlüsselwörter

Trousseau-Syndrom - direkte Thrombininhibitoren - rezidivierende Thromboembolien - Dabigatran - Argatroban

Keywords

Trousseau's syndrome - direct thrombin inhibitors - recurrent thromboembolism - Dabigatran - Argatroban

• Literatur

• 1 Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thromb Haemost 2002; 87 (04) 575-579.
• 2 Varki A. Trousseau's syndrome: multiple definitions and multiple mechanisms. Blood 2007; 110 (06) 1723-1729.
• 3 Trousseau A. editor Plegmasia alba dolens. Paris. London, United Kingdom: New Syndenham Society; 1872
• 4 Gerotziafas GT, Papageorgiou C, Hatmi M. et al. Clinical studies with anticoagulants to improve survival in cancer patients. Pathophysiol Haemost Thromb 2008; 36 03–4 204-211.
• 5 Trujillo-Santos J, Prandoni P, Rivron-Guillot K. et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost 2008; 6 (02) 251-255.
• 6 Trujillo-Santos J, Nieto JA, Tiberio G. et al. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100 (03) 435-439.
• 7 Lee AY, Rickles FR, Julian JA. et al. Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous thromboembolism. J Clin Oncol 2005; 23 (010) 2123-2129.
• 8 Lee AY, Levine MN, Baker RI. et al. Low-molecularweight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (02) 146-153.
• 9 Hull RD, Pineo GF, Brant RF. et al. Long-term lowmolecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 2006; 119 (012) 1062-1072.
• 10 Carrier M, Le Gal G, Cho R. et al. Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients. J Thromb Haemost 2009; 7 (05) 760-765.
• 11 den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol 2011; 29 (017) 2405-2409.