Drug-related thrombosis in hematologic malignancies

Cancer patients are at increased risk for thrombosis. Among the predisposing factors for the hemostatic imbalance, drugs have a definite role. Induction of thrombosis by drugs involves a variety of mechanisms: Enhancement of procoagulant activity, reduction in anticoagulants synthesis, stimulation of platelet aggregation and endothelial damage. L-asparaginase is associated with thrombotic events, mainly in the venous system. Supportive therapy with fresh frozen plasma is probably insufficient and heparin needs further evaluation. Venous thromboembolism has recently emerged following thalidomide use particularly in combination chemotherapy. The hematopoietic growth factors granulocyte colony-stimulating factor, macrophage-granulocyte colony-stimulating factor and erythropoietin have also been implicated in venous as well as in arterial thrombotic events. Numerous drugs are associated with thrombotic microangiopathy i.e., cyclosporine A, tacrolimus, cisplatin, bleomycin, gemcitabine. The clinical presentation, pathological mechanisms and therapeutic modalities are discussed.