Thrombembolie-Risikofaktoren und Prophylaxe

Zusammenfassung

Venöse Thromboembolien stellen eine wichtige Komplikation bei Tumorpatienten, da sie bei diesen Patienten gehäuft auftreten und eine relevante Morbidität bedingen. Das Risiko für thromboembolische Komplikationen bei Tumorpatienten liegt 3–9-mal höher als bei Nichttumorpatienten und stellt die zweithäufigste Todesursache bei Tumorpatienten dar. Das Thromboserisiko hängt neben der tumorinduzierten Koagulopathie von individuellen Faktoren, der Art und dem Stadium der Krebserkrankung, der Zeit seit der Krebsdiagnose sowie der Art einer systemischen Krebstherapie ab. Eine Thromboseprophylaxe bei Tumorpatienten ist wirksam, kann jedoch mit erhöhten Blutungen einhergehen. Auch wenn dezidierte Empfehlungen für einzelne Tumorentitäten aktuell nicht vorliegen, empfehlen internationale Leitlinien prophylaktische Maßnahmen bei Hochrisikopatienten. So kann ein Thromboserisiko von >8–10% als Indikation für eine Thromboseprophylaxe angesehen werden. Dieses Risiko wurde bei Patienten mit einem Khorana-Score von ≥2 erreicht und sollte individuell mithilfe der Nomogramme berechnet werden. Vor allem bei Patienten mit geringem Blutungsrisiko wird diese Empfehlung ausgesprochen. Während des Arztgesprächs sollten zudem Risikofaktoren und Symptome eines thromboembolischen Events thematisiert und Materialien zur Patientenaufklärung ausgehändigt werden.

Abstract

Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3–9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8–10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.

Fazit für die Praxis

• Thromboembolischen Komplikationen treten bei Tumorpatienten gehäuft auf und können eine relevante Morbidität bedingen.

• Das Thromboserisiko hängt neben der tumorinduzierten Koagulopathie von individuellen Faktoren, der Art und dem Stadium der Krebserkrankung, der Zeit seit der Krebsdiagnose sowie der Art einer systemischen Krebstherapie ab.

• Internationale Leitlinien empfehlen prophylaktische Maßnahmen bei Hochrisikopatienten, dezidierte Empfehlungen für einzelne Tumorentitäten liegen jedoch aktuell nicht vor.

• Eine Thromboseprophylaxe bei Tumorpatienten ist wirksam, kann jedoch mit erhöhten Blutungen einhergehen.

• Eine primäre Thromboseprophylaxe mit NMH oder DOAKs kann bei ambulanten und stationären Tumorpatienten mit hohem Risiko anhand validierter Risikomodelle erwogen werden.

• Risikofaktoren der Thromboseentstehung sowie Symptome eines thromboembolischen Events sollten im Patientengespräch detailliert thematisiert werden.

Schlüsselwörter

venöse thromboembolische Komplikationen - urogenitale Tumore - Thrombosprophylaxe

Keywords

venous thromboembolic events - genitourinary cancer - thromboembolic prophylaxis

Publication History

Received: 17 February 2023

Accepted after revision: 22 May 2023

Article published online:
20 June 2023

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