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Thrombotic complications in patients with kidney cancer and their prevention

DOI 10.18127/j20700997-201904-01

Keywords:

O.V. Somonova – Dr. Sc. (Med.), Professor, Department of Clinical Biochemistry and Laboratory Diagnostics, A.I. Evdokimova Moscow State Medical and Dental University
E-mail: somonova@mail.ru
S.L. Teodorovich – oncologist, N.N. Blokhin National Medical Research Center of Oncology (Moscow)
A.L. Elizarova – Ph.D. (Biol.), Senior Research Scientist, N.N. Blokhin National Medical Research Center of Oncology (Moscow)
E-mail: anna_el@rambler.ru
N.E. Kushlinskii – Ph.D. (Med.), Professor, Corresponding member of RAS, Head of the Department of Clinical Biochemistry and Laboratory Diagnostics, A.I. Evdokimov Moscow State Medical and Dental University
E-mail: biochimia@yandex.ru


Cancer patients are at high risk of thrombotic complications that worsen the outcome of antitumor treatment and occupy one of the leading places among the causes of death. Thrombosis in an oncologic patient increases the risk of death by 30 times, which is associated with the development of fatal thromboembolism and a more aggressive course of the tumor process. The leading role in the pathogenesis of thrombotic complications is played by abnormalities in the hemostasis system, caused both by the tumor itself and by treatment methods. Currently, low molecular weight heparins (LMWH) are the main drugs in the prevention and treatment of thrombotic complications in cancer patients. The effect of sodium dalteparin (fragmin) on the hemostatic system and the frequency of thrombotic complications in 60 patients with metastatic kidney cancer receiving immunotherapy was studied. The use of dalteparin sodium on the background of immunotherapy reduces the intensity of intravascular coagulation and the frequency of venous thrombosis. In the group of patients who did not receive medical prophylaxis, the incidence of complications was 6 (20%) cases, in the group of patients who received low molecular weight heparins – 1 (3%) cases (p<0.05). In N.N.Blokhin NMRC of Oncology conducted the first randomized study of the effectiveness of the combination of LMWH and immunotherapy in comparison with a single immunotherapy in patients with metastatic kidney cancer and hypercoagulation (Tsimafeyeu I.V. et al., 2009). The results of the studies showed that the median of tumor-specific survival in the group of patients who received fragmin against immunotherapy was 16.5 months [95% CI 12-21 months] versus 9 months [95% CI 7-12 months] in the group of patients who received only immunotherapy (p=0.019). Control of the disease (objective response + stabilization) in the group with fragmin was achieved more often than in patients who received only immunotherapy. The effect of therapy (objective response + partial response) was observed in 75% of patients in group I compared with 35% of patients in the control group (p=0.002).

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June 24, 2020
May 29, 2020

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