Канцерассоциированный тромбоз: патогенез, факторы риска и лечение

Билялов А.И., Нестерова А.И., Бодунова Н.А., Зинченко С.В. Канцерассоциированный тромбоз: патогенез, факторы риска и лечение. Современная Онкология. 2025;27(2):93–101. DOI: 10.26442/18151434.2025.2.203324

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Bilyalov AI, Nesterova AI, Bodunova NA, Zinchenko SV. Cancer-associated thrombosis: Pathogenesis, risk factors, and treatment. A review. Journal of Modern Oncology. 2025;27(2):93–101. DOI: 10.26442/18151434.2025.2.203324

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Аннотация

Канцерассоциированный тромбоз (КАТ) является одним из наиболее частых и опасных осложнений злокачественных новообразований, занимая 2-е место среди причин смертности у онкологических пациентов. В статье представлен обзор современных данных о патогенезе тромбоза у онкологических больных, включая ключевую роль опухолевых клеток, воспалительных цитокинов, внеклеточных ловушек нейтрофилов и нарушения регуляции гемостаза. Рассматриваются эпидемиология КАТ, индивидуальные (возраст, сопутствующие заболевания, подвижность) и опухолезависимые (локализация, стадия, гистология) факторы риска, а также влияние различных видов противоопухолевой терапии, включая химиотерапию, хирургические вмешательства и использование центральных венозных катетеров. Особое внимание уделено современным подходам к профилактике и лечению КАТ, включая применение прямых пероральных антикоагулянтов, их преимущества по сравнению с низкомолекулярными гепаринами и данные крупных рандомизированных исследований (CARAVAGGIO и API-CAT). Обзор включает анализ международных и российских клинических рекомендаций (ASCO, NCCN, RUSSCO), акцентируя внимание на необходимости индивидуального подхода с учетом клинической ситуации, риска кровотечений и лекарственных взаимодействий. Представленные данные подчеркивают значимость своевременного выявления КАТ и рационального выбора терапии для снижения риска осложнений и улучшения прогноза у онкологических пациентов. Результаты обзора подтверждают, что использование прямых пероральных антикоагулянтов, особенно апиксабана, способно повысить качество жизни и выживаемость онкологических пациентов с венозными тромбоэмболиями. Кроме того, установлено, что применение сниженной дозы апиксабана (2,5 мг дважды в сутки) после 6 мес терапии сохраняет эффективность в профилактике рецидивов венозных тромбоэмболий и снижает частоту клинически значимых кровотечений по сравнению с полной дозой.

Ключевые слова: канцерассоциированный тромбоз, прямой пероральный антикоагулянт, венозная тромбоэмболия, артериальная тромбоэмболия, протромботический эффект химиотерапевтических препаратов, онкотромбоз, апиксабан, далтепарин, ривароксабан, эдоксабан

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Cancer-associated thrombosis (CAT) is one of the most frequent and dangerous complications of malignancies, ranking 2nd among the causes of death in cancer patients. The article presents an overview of current data on the pathogenesis of thrombosis in cancer patients, including the key role of tumor cells, inflammatory cytokines, neutrophil extracellular traps, and dysregulation of hemostasis. CAT epidemiology, individual (age, comorbidities, mobility) and tumor-dependent (location, stage, histology) risk factors, as well as the effect of various types of anticancer therapy, including chemotherapy, surgery, and the use of central venous catheters, are considered. Particular attention is paid to modern approaches to the prevention and treatment of CAT, including direct oral anticoagulants, their advantages over low molecular weight heparins, and data from large randomized trials (CARAVAGGIO and API-CAT). The review includes an analysis of international and Russian clinical guidelines (ASCO, NCCN, RUSSCO), focusing on the need for an individual approach, considering the clinical situation, the risk of bleeding, and drug interactions. The presented data emphasize the importance of timely detection of CAT and rational choice of therapy to reduce the risk of complications and improve the prognosis in cancer patients. The presented data emphasize the importance of timely detection of CAT and rational choice of therapy to reduce the risk of complications and improve the prognosis in cancer patients. In addition, a reduced dose of apixaban (2.5 mg twice daily) after 6 months of therapy was found to be effective in preventing the recurrence of venous thromboembolism and reducing the incidence of clinically significant bleeding compared to the full dose.

Keywords: cancer-associated thrombosis, direct oral anticoagulant, venous thromboembolism, arterial thromboembolism, prothrombotic effect of chemotherapeutic drugs, thrombosis in oncologic patients, apixaban, dalteparin, rivaroxaban, edoxaban

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1. Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. Lancet Oncol. 2005;6(6):401-10. DOI:10.1016/S1470-2045(05)70207-2
2. Noble S, Pasi J. Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer. 2010;102(Suppl. 1):S2-9. DOI:10.1038/sj.bjc.6605599
3. Levi M. Cancer-related coagulopathies. Thromb Res. 2014;133(Suppl. 2):S70-5. DOI:10.1016/S0049-3848(14)50012-6
4. Eichinger S. Cancer associated thrombosis: Risk factors and outcomes. Thromb Res. 2016;140(Suppl. 1):S12-7. DOI:10.1016/S0049-3848(16)30092-5
5. Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715-22. DOI:10.1001/jama.293.6.715
6. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: A population-based case-control study. Arch Intern Med. 2000;160(6):809-15. DOI:10.1001/archinte.160.6.809
7. Navi BB, Reiner AS, Kamel H, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol. 2017;70(8):926-38. DOI:10.1016/j.jacc.2017.06.047
8. Fuchs TA, Brill A, Wagner DD. Neutrophil extracellular trap (NET) impact on deep vein thrombosis. Arterioscler Thromb Vasc Biol. 2012;32(8):1777-83. DOI:10.1161/ATVBAHA.111.242859
9. Naess IA, Christiansen SC, Romundstad P, et al. Incidence and mortality of venous thrombosis: A population-based study. J Thromb Haemost. 2007;5(4):692-9. DOI:10.1111/j.1538-7836.2007.02450.x
10. Connolly GC, Francis CW. Cancer-associated thrombosis. Hematology Am Soc Hematol Educ Program. 2013;2013:684-91. DOI:10.1182/asheducation-2013.1.684
11. Agnelli G, Verso M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost. 2011;9(Suppl. 1):316-24. DOI:10.1111/j.1538-7836.2011.04346
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Авторы

А.И. Билялов*¹, А.И. Нестерова^2–4, Н.А. Бодунова¹, С.В. Зинченко^2,3

¹ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
²ГАУЗ «Республиканский клинический онкологический диспансер им. проф. М.З. Сигала», Казань, Россия;
³ФГАОУ ВО «Казанский (Приволжский) федеральный университет», Казань, Россия;
⁴Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Казань, Россия
*BilyalovAir@yandex.ru

________________________________________________

Airat I. Bilyalov*¹, Alfiya I. Nesterova^2–4, Natalia A. Bodunova¹, Sergey V. Zinchenko^2,3

¹Loginov Moscow Clinical Scientific Center, Moscow, Russia;
²Segal Republican Clinical Oncological Dispensary, Kazan, Russia;
³Kazan (Volga region) Federal University, Kazan, Russia;
⁴Kazan State Medical Academy – branch of the Russian Medical Academy of Continuous Professional Education, Kazan, Russia
*BilyalovAir@yandex.ru

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