28 KB80 KB26 KB192920262007Kupnik, DejanTakač, Iztokštevilka:35 straniletnik:76str. 179-183ISSN:1318-0347COBISSID:2603583URN:URN:NBN:SI:doc-F1AV7ONKslSlovensko zdravniško društvoZdravniški vestnikAnticoagulantsantikoagulacijsko zdravljenjeAntikoagulantidiagnosisDiagnostikaHeparin nizke molekularne težeHeparin, Low-Molecular-WeightJajčnik, novotvorbejajčnikiOvarian NeoplasmsPrognosisPrognozarak (medicina)therapyThromboembolismTrombembolijaZdravljenjeDiagnostični in prognostični pomen venske trombembolije pri raku jajčnikov| Diagnostic and prognostic importance of venous thromboembolism in ovarian cancer|Background. Cancer and its chemotherapy are well known risk factors for venous thromboembolism. The later can be the first sign of an occult malignancy, especially if it is recurrent one. Venous thromboembolism is also a common cause of morbidity and mortality among cancer patients. In time of the first presentation of venous thromboembolism in the context of underlying cancer the advanced stage of cancer is usually present and this is associated with poor prognosis. Ovarian cancer which is diagnosed within four months after an episode of venous thromboembolism is usually in advanced stages with more aggressive biological properties. Conclusions. Low-molecular-weight-heparins are the cornerstone of treatment and prophylaxis of venous thromboembolism associated with cancer for the first 3 to 6 months after acute venous thromboembolic event. In accordance with current consensus they are replaced with oral anticoagulants after 6 months of treatment. According to recent trials low- molecular-weight-heparins cause less side effects and there are less recurrent venous thromboembolisms than with peroral anticoagulant therapy. Accordingly their impact on improved survival of cancer patients is under intensive research. Unfortunately, there is currently no screening test for ovarian cancer which would lead to improved survivalIzhodišča. Rak in zdravljenje raka sta znana dejavnika tveganja za vensko trombembolijo. Slednja je lahko prvi znak še neodkrite maligne bolezni, še posebej, če se ponavlja. Je pomemben vzrok obolevnosti in smrtnosti bolnikov z rakom. Ob prvi epizodi venske trombembolije, če je v sklopu raka, je rak najpogosteje že v napredovali fazi in ima slabo napoved izida. Tudi kadar se diagnoza raka jajčnikov postavi znotraj štirih mesecev po venski trombemboliji, je to povezano z bolj napredovalo boleznijo in agresivnejšim tipom raka. Pri začetnem in nadaljnjem 3-do 6-mesečnem antikoagulacijskem zdravljenju po venski trombemboliji v sklopu raka se uporabljajo nizkomolekularni heparini, ki jih po šestih mesecih po sedanjem dogovoru zamenjajo peroralna antikoagulacijska zdravila. Dosedanje raziskave, na podlagi katerih pa še ni mogoče napraviti zaključkov, kažejo, da je zdravljenje z nizkomolekularnimi heparini povezano z manj stranskimi učinki in z manj ponovnimi venskimi trombembolijami kot peroralno antikoagulacijsko zdravljenje. Vsaj v populaciji bolnikov z boljšo napovedjo izida verjetno tudi izboljša preživetje, zaradi vpliva na biološko obnašanje tumorja, kar zmanjša njegovo agresivnost. Ustreznega presejalnega testa za ženske, s katerim pa bi odkrili raka jajčnikov in s tem tudi izboljšali napoved izida, za sedaj žal niTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo