ABSTRACT
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. On the basis of results from randomized controlled trials, direct oral anticoagulants (DOACs) are now recommended for the treatment of cancer-associated VTE. The decision to use a DOAC requires consideration of bleeding risk, particularly in patients with gastrointestinal (GI) malignancies, the cost-benefit and convenience of oral therapy, and patient preference. While efficacy with apixaban, edoxaban, and rivaroxaban versus dalteparin has been consistent in the treatment of cancer-associated VTE, heterogeneity is evident with respect to major GI bleeding, with an increased risk with edoxaban and rivaroxaban but not apixaban. Although cost and accessibility vary in different countries of Latin America, DOACs should be considered for the long-term treatment of cancer-associated VTE in all patients who are likely to benefit. Apixaban may be the preferred DOAC in patients with GI malignancies and LMWH may be preferred for patients with upper or unresected lower GI tumors. Vitamin K antagonists should only be used for anticoagulation when DOACs and low molecular weight heparin are inaccessible or unsuitable.
Subject(s)
Anticoagulants/administration & dosage , Neoplasms/complications , Venous Thromboembolism/drug therapy , Administration, Oral , Blood Coagulation/drug effects , Humans , Incidence , Latin America/epidemiology , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiologyABSTRACT
Resumen Desde hace algunos años se ha sugerido que los pacientes con síndrome de apnea-hipopnea obstructiva del sueño sin tratamiento tienen una mayor probabilidad de cáncer sólido y de mortalidad por cáncer, sin embargo hay dudas frente al tema. Por esta razón, en este artículo se describen, por un lado, los estudios más importantes al respecto y, por el otro, la fisiopatología propuesta por los investigadores que plantean esta asociación donde la hipoxia, el daño oxidativo del DNA, la disfunción endotelial y la disrupción de la arquitectura del sueño juegan un papel fundamental, además de otras consideraciones interesantes.
Abstract For some years, it has been suggested that patients with untreated obstructive sleep apnea-hypopnea syndrome are more likely to have solid cancer and increased cancer mortality, although some doubt on the issue has arisen. In consequence, this article describes, on the one hand, the most important studies on the topic and, on the other, the pathophysiology proposed by researchers, who formulate an association in which hypoxia, DNA oxidative damage, endothelial dysfunction and the disruption of the dream architecture play a fundamental role, in addition to other interesting considerations.
