Alterations of Hemostasis Associated With Malignancy: Etiology, Pathophysiology, Diagnosis and Management

Bick, Rodger L.

doi:10.1055/s-0028-1087142

Cited by 125 publications

(27 citation statements)

References 66 publications

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“…Thrombotic complications can also delay or interfere with anticancer therapy [2]. Thromboembolism may be the first clinical manifestation of an underlying malignancy [3][4][5][6][7]. It is also recognized that thrombosis is more commonly seen in patients with established cancer: up to 15% of patients with cancer develop symptomatic VTE, and these patients have a worse prognosis as compared to those without VTE [6].…”

Section: Introductionmentioning

confidence: 99%

“…Thromboembolism may be the first clinical manifestation of an underlying malignancy [3][4][5][6][7]. It is also recognized that thrombosis is more commonly seen in patients with established cancer: up to 15% of patients with cancer develop symptomatic VTE, and these patients have a worse prognosis as compared to those without VTE [6]. One out of seven hospitalized patients with cancer die from pulmonary embolism (PE) [7], 60% of which with localized cancer, with an expected longer survival in the absence of the thromboembolic complication.…”

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism and cancer: a systematic review

Rodrigues

Ferrarotto

Filho

et al. 2010

J Thromb Thrombolysis

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Venous thromboembolism (VTE) is a serious and potentially fatal disorder, which is often associated with a significant impact on the quality of life and on the clinical outcome of cancer patients. The pathophysiology of the association between thrombosis and cancer is complex: malignancy is associated with a baseline hypercoagulable state due to many factors including release of inflammatory cytokines, activation of the clotting system, expression of hemostatic proteins on tumor cells, inhibition of natural anticoagulants, and impaired fibrinolysis. Several risk factors, related to the patient, the disease, and the therapeutic interventions, have been identified as contributing to the occurrence of VTE. There is convincing evidence to recommend the use of heparins or fondaparinux for prevention of VTE in selected cancer patients, and, especially in some particular types of malignancies and cancer treatments. Management of VTE in patients with cancer is more challenging and bleeding complications associated with the use of anticoagulants are significantly higher in cancer patients than in those without malignancy. Important issues that need to be considered in all cases are interference with anticancer therapy, inconvenience of treatment, and impact on quality of life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism and cancer: a systematic review

Rodrigues

Ferrarotto

Filho

et al. 2010

J Thromb Thrombolysis

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“…Between four and 20% of cancer patients develop VTE during the course of their disease [5] and cancer associated thrombosis (CAT) remains the second commonest cause of death after disease progression [5]. It is known that there are a number of risk factors for VTE in patients with cancer and these are both directly and indirectly associated with tumour procoagulants, such as tissue factor (TF) [6]. The histology of primary tumour and stage of disease are also important factors, as are metastatic burden, age, surgery and chemotherapy [3,4,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Application of ROTEM to assess hypercoagulability in patients with lung cancer

Davies

Harrison

Sabra

et al. 2015

Thrombosis Research

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“…Bleeding diathesis is commonly seen in this disease and it has been estimated that as many as onethird of the patients with plasma cell myeloma may have this complication. [12,13] The common abnormalities contributing to bleeding diathesis include thrombocytopenia, platelet dysfunction related to uremia, hyperviscosity with bleeding tendency, disorders of coagulation factors, etc. The possible mechanisms by which coagulopathy could develop in patients with dysproteinemias in MM include: paraprotein interference with the normal function of coagulation factor(s) (i.e.…”

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confidence: 99%

“…by complexing with specific clotting factors), enhancement of the clearance of coagulation factor(s) by the reticuloendothelial system, anticoagulant activity of paraproteins, impaired normal platelet function, excessive fibrinolysis, and hyperviscosity. [2][3][4][5]12] Patients on bortezomib chemotherapy also often develop low platelet counts, but these usually recover rapidly.[14] During melphalan, prednisolone, and thalidomide chemotherapy, periodic blood tests are needed to ensure that an individual has adequate levels of white blood cells and platelets. The dose of melphalan must be adjusted based on these findings.…”

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confidence: 99%

Spontaneous acute subdural hematoma in a patient with multiple myeloma

Wani¹,

Kumar²,

Ramzan³

et al. 2012

IJNS

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A b S T R A c TAcute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy. Bleeding diathesis is commonly seen in this disease and it has been estimated that as many as onethird of the patients with plasma cell myeloma may have this complication. [12,13] The common abnormalities contributing to bleeding diathesis include thrombocytopenia, platelet dysfunction related to uremia, hyperviscosity with bleeding tendency, disorders of coagulation factors, etc. The possible mechanisms by which coagulopathy could develop in patients with dysproteinemias in MM include: paraprotein interference with the normal function of coagulation factor(s) (i.e. by complexing with specific clotting factors), enhancement of the clearance of coagulation factor(s) by the reticuloendothelial system, anticoagulant activity of paraproteins, impaired normal platelet function, excessive fibrinolysis, and hyperviscosity. [2][3][4][5]12] Patients on bortezomib chemotherapy also often develop low platelet counts, but these usually recover rapidly.[14] During melphalan, prednisolone, and thalidomide chemotherapy, periodic blood tests are needed to ensure that an individual has adequate levels of white blood cells and platelets. The dose of melphalan must be adjusted based on these findings. Paul et al. reported one death due to SDH in the dexamethasone group in a study comparing bortezomib and high-dose dexamethasone for relapsed MM.[15] Thrombocytopenia does not usually result in any symptoms, but if the platelet count is very low there is an increased risk of bleeding. Transfusion of platelets may be required temporarily. Keith et al., in their review of 23 cases of MM, described one patient with unilateral large subdural collection looking like acute SDH on imageology, but subsequently it turned out to be a malignant effusion. [16] Spontaneous acute SDH is a rare but serious condition. This term is based simply on the absence of a traumatic history. [8,17,18] Mortality rate has been reported to be between 60 and 76.5%. [19] Early surgical intervention is often imperative for hematomas with significant mass effect. The survival rate for surgery within 4 h of acute onset compared to surgery after 4 h is 50 to 0%, respectively. Other favorable variables include a high glasgow coma score score upon admission, appropriate pupillary reactivity, and young age. CONCLUSIONAlthough coagulopathy-associated spontaneous acute SDH has been well documented, spontaneous acute SDH related to coagulopathy, particularly in MM, has never been recognized.

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Alterations of Hemostasis Associated With Malignancy: Etiology, Pathophysiology, Diagnosis and Management

Cited by 125 publications

References 66 publications

Venous thromboembolism and cancer: a systematic review

Venous thromboembolism and cancer: a systematic review

Application of ROTEM to assess hypercoagulability in patients with lung cancer

Spontaneous acute subdural hematoma in a patient with multiple myeloma

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