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Hemostatic alterations in cancer patients
F R Rickles1, M Levine, R L Edwards
1Department of Medicine, University of Connecticut School of Medicine, Farmington 06032.
Cancer Metastasis Reviews
|November 1, 1992
Summary
Cancer patients often show hypercoagulability, increasing thromboembolic disease (TED) risk. Current coagulation tests don't reliably predict TED, but prophylactic anticoagulation is recommended for high-risk cancer patients.
Area of Science:
- Oncology
- Hematology
- Thrombosis Research
Background:
- Nearly all cancer patients exhibit laboratory hypercoagulability, with some developing clinical thromboembolic disease (TED).
- Existing coagulation tests and sensitive hypercoagulability markers (e.g., fibrinopeptide A, thrombin-antithrombin complexes) correlate with disease activity but do not reliably predict TED in cancer patients.
- Pathogenesis of TED in cancer involves tumor procoagulants, stasis, and endothelial damage, with variable importance across cancer types.
Purpose of the Study:
- To review the current understanding of hypercoagulability and thromboembolic disease (TED) in cancer patients.
- To evaluate the predictive value of laboratory coagulation tests for TED in cancer.
- To discuss the role of various mechanisms and therapies in managing TED risk in cancer.
Main Methods:
- Review of prospective trials and smaller studies on anticoagulant drugs in cancer treatment.
- Analysis of data from routine and sensitive laboratory tests of blood coagulation.
- Examination of pathogenic mechanisms including tumor procoagulants, stasis, endothelial damage, and treatment-related factors.
Main Results:
- Laboratory evidence of hypercoagulability is nearly universal in cancer patients; however, no current coagulation tests reliably predict TED.
- Risk for TED is substantial with surgery and likely increased by chemotherapy and hormonal therapy, especially with indwelling venous catheters.
- Vascular injury is a likely cause of catheter-related thrombosis, potentially preventable with low-dose coumadin, though its utility in breast cancer treatment is under investigation.
Conclusions:
- Prophylactic antithrombotic therapy should be considered for most cancer patients undergoing surgery.
- Chemotherapy and hormonal therapy may increase TED risk, particularly in patients with venous catheters.
- Prophylactic anticoagulation is recommended for high-risk cancer patients, with ongoing research into specific agents and patient populations.