Estado hipercoagulável

Anticoagulantes orais diretos em pacientes com câncer selecionados

As diretrizes da National Comprehensive Cancer Network dos EUA sugerem considerar apixabana para a profilaxia do tromboembolismo venoso em pacientes com câncer ginecológico, e a rivaroxabana para os pacientes após uma cirurgia laparoscópica para câncer colorretal.[150]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease [internet publication]. https://www.nccn.org/guidelines/category_1 [160]Becattini C, Pace U, Pirozzi F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022 Aug 25;140(8):900-8. https://ashpublications.org/blood/article/140/8/900/485280/Rivaroxaban-vs-placebo-for-extended-antithrombotic http://www.ncbi.nlm.nih.gov/pubmed/35580191?tool=bestpractice.com [161]Guntupalli SR, Brennecke A, Behbakht K, et al. Safety and efficacy of apixaban vs enoxaparin for preventing postoperative venous thromboembolism in women undergoing surgery for gynecologic malignant neoplasm: a randomized clinical trial. JAMA Netw Open. 2020 Jun 1;3(6):e207410. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767675 http://www.ncbi.nlm.nih.gov/pubmed/32589230?tool=bestpractice.com ​​​​ As diretrizes da American Society of Clinical Oncology sugerem que os pacientes submetidos a uma cirurgia oncológica podem mudar para rivaroxabana ou apixabana para a tromboprofilaxia pós-operatória prolongada após um período inicial de heparina de baixo peso molecular ou heparina não fracionada.[148]Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline Update. J Clin Oncol. 2023 Jun 1;41(16):3063-71. https://ascopubs.org/doi/10.1200/JCO.23.00294 http://www.ncbi.nlm.nih.gov/pubmed/37075273?tool=bestpractice.com [160]Becattini C, Pace U, Pirozzi F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022 Aug 25;140(8):900-8. https://ashpublications.org/blood/article/140/8/900/485280/Rivaroxaban-vs-placebo-for-extended-antithrombotic http://www.ncbi.nlm.nih.gov/pubmed/35580191?tool=bestpractice.com [161]Guntupalli SR, Brennecke A, Behbakht K, et al. Safety and efficacy of apixaban vs enoxaparin for preventing postoperative venous thromboembolism in women undergoing surgery for gynecologic malignant neoplasm: a randomized clinical trial. JAMA Netw Open. 2020 Jun 1;3(6):e207410. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767675 http://www.ncbi.nlm.nih.gov/pubmed/32589230?tool=bestpractice.com ​​​​ As evidências para o uso da rivaroxabana e da apixabana nesses cenários são limitadas. Um esquema oral pode melhorar a adesão em alguns pacientes.