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Inicio Medicina Clínica Actitud ante el riesgo tromboembólico en pacientes con cáncer
Journal Information
Vol. 139. Issue S2.
Actualización en enfermedad tromboembólica
Pages 31-35 (October 2012)
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Vol. 139. Issue S2.
Actualización en enfermedad tromboembólica
Pages 31-35 (October 2012)
Actitud ante el riesgo tromboembólico en pacientes con cáncer
Management of thromboembolic risk in patients with cancer
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A. Javier Trujillo Santos
Servicio de Medicina Interna, Hospital General Universitario Santa Lucía, Complejo Hospitalario Área 2, Cartagena, Murcia, España
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Resumen

La tromboembolia venosa es una complicación frecuente de los pacientes con cáncer, que influye en su morbilidad y mortalidad. El riesgo de padecerla difiere en virtud de determinadas características del tumor y de circunstancias propias del paciente afectado o de los tratamientos instaurados. Si bien se ha demostrado el beneficio de la tromboprofilaxis en determinados subgrupos de pacientes con cáncer, actualmente no se recomienda su prescripción de forma genérica salvo que concurran otros factores de riesgo, o en el caso de pacientes con mieloma múltiple que sean tratados con talidomida o lenalidomida. La inserción de un catéter venoso central en estos pacientes no implica la prescripción de tromboprofilaxis, aunque se conocen los factores de riesgo de trombosis asociada al catéter. Finalmente se ha definido un modelo de predicción del riesgo tromboembólico en pacientes ambulatorios con cáncer que inician quimioterapia, que ha sido externamente validado y complementado con la adición de los valores de 2 biomarcadores.

Palabras clave:
Cáncer
Tromboembolia venosa
Profilaxis
Modelo de predicción de riesgo
Catéter venoso central
Abstract

Venous thromboembolism is a frequent complication in cancer patients and affects their morbidity and mortality. The risk of this event differs according to the characteristics of the tumor, the patient's circumstances, and the treatments provided. Although the benefits of thromboprophylaxis in certain subgroups of patients with cancer have been demonstrated, currently generic prescription is not recommended unless other risk factors are present, or the patient has multiple myeloma and has been treated with thalidomide or lenalidomide. The insertion of a central venous catheter in these patients does not imply prescription of thromboprophylaxis, although the risk factors for catheter thrombosis are known. Finally, a risk scoring model for the prediction of venous thromboembolism has been defined in outpatients with cancer starting chemotherapy, which has been externally validated and supplemented with the addition of two biomarkers.

Keywords:
Cancer
Venous thromboembolism
Thromboprophylaxis
Risk prediction model
Central venous catheter

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