Hematological Issues in Critically Ill Patients with Cancer

Carlson, Karen-Sue; DeSancho, Maria T.

doi:10.1016/j.ccc.2009.09.006

Cited by 16 publications

(17 citation statements)

References 111 publications

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“…We believe that the cornerstone of the index case report is the association of terminal malignancy, persistent platelet activation despite conventional dual antiplatelet therapy, and stent thrombosis of the large artery. Malignancy per se activates various hemostatic components, such as coagulation [14] and fibrinolysis [15], disrupts vascular endothelium [16], increases leukocyte rolling [17], and enhances platelet activity [18]. In addition, modern therapeutic strategies in cancer patients such as chemotherapy [19] and radiation [20] may also cause thrombophilia and platelet activation-provoking stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Late Common Iliac Artery Stent Thrombosis in a Patient with Terminal Malignancy

et al. 2010

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Narrowing of the iliac artery is a common presentation of systemic atherosclerosis. With the recent development of invasive techniques, angioplasty and stenting offer excellent results for fixing limb ischemia of aorto-iliac arteries. However, despite novel interventional approaches and constantly increasing experience, complications such as distal embolization, stent migration, acute or subacute iliac artery occlusion, dissection, and perforations are still challenging. Early restenosis and/or reocclusion of peripheral artery stents is uncommon, but the risk of delayed or late thrombotic occlusions of iliac artery stents is unclear. Although with questionable impact, hypercoagulable state or patient noncompliance may contribute to the pathogenesis of stent thrombosis. We describe a patient with terminal renal cell carcinoma who developed late iliac artery stent thrombosis despite dual chronic antiplatelet therapy with aspirin and clopidogrel.

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Section: Discussionmentioning

confidence: 99%

Late Common Iliac Artery Stent Thrombosis in a Patient with Terminal Malignancy

et al. 2010

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“…Examination of the peripheral smear may reveal schistocytes or microspherocytes, suggesting a destructive process (Carlson and DeSancho, 2010). However, examination of the peripheral blood smear is a critical component in identifying causes of thrombocytopenia.…”

Section: Monitoring Elementsmentioning

confidence: 99%

“…The most common site of bleeding is mucocutaneous including wet purpura, bleeding gums, petechiae, ecchymoses, epistaxis, gastrointestinal, or genitourinary bleeding (Carlson and DeSancho, 2010). In patients with fever, sepsis, trauma, or untreated hematologic malignancy, bleeding may be seen at higher platelet counts.…”

Section: Monitoring Elementsmentioning

confidence: 99%

“…However, there are no evidence-based guidelines outlining the best, safest parameter for platelet transfusion. For patients who are experiencing bleeding or require an invasive procedure such as placement of a central venous catheter, biopsy, lumbar puncture, thoracentesis, or paracentesis, platelet count should be maintained above 50 000/mm 3 (Carlson and DeSancho, 2010). Studies have indicated that a platelet threshold of 10 000/ mm 3 is safe and well tolerated (Benjamin and Anderson, 2002).…”

Section: Managementmentioning

confidence: 99%

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Oncologic emergencies in critical care

Barbarotta

2015

Critical Care Nursing

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“…However, in other settings such as the ICU or in long-term hospitalised patients with an elevated risk for PTE, several factors may influence D-dimer and fibrinogen concentrations 12-16. Furthermore, in these patients, there was less accessibility to CT angiography and more complications were experienced with the use of it 17,18.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

Hajsadeghi

Kerman

Khojandi

et al. 2012

CVJA

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IntroductionPulmonary thromboembolism (PTE) may increase D-dimer and decrease fibrinogen levels. However, in settings such as intensive care units (ICU) and in long-term hospitalised patients, several factors may influence D-dimer and fibrinogen concentrations and make them unreliable indicators for the diagnosis of PTE. The aim of this study was to evaluate the accuracy of D-dimer:fibrinogen ratio (DDFR) for the diagnosis of PTE in ICU patients.MethodsICU patients who were suspected of having a first PTE and had no history of using anti-coagulants and contraceptives were included in the study. Levels of D-dimer and fibrinogen were measured for each patient prior to any intervention. Angiography or CT angiography was done in order to establish a definite diagnosis for each patient. Suitable analytical tests were performed to compare means.ResultsEighty-one patients were included in the study, of whom 41 had PTE and 40 did not. Mean values of D-dimer and fibrinogen were 3.97 ± 3.22 μg/ml and 560.6 ± 197.3 mg/dl, respectively. Significantly higher levels of D-dimer (4.65 ± 3.46 vs 2.25 ± 2.55 μg/ml, p = 0.006) and DDFR (0.913 ± 0.716 vs 483 ± 0.440 × 10-3, p = 0.003) were seen in PTE patients than in those without PTE. Receiver operating characteristic (ROC) analysis showed a 70.3% sensitivity and 70.1% specificity with a D-dimer value of 2.43 μg/ml (AUC = 0.714, p = 0.002) as the best cut-off point; and a 70.3% sensitivity and 61.6% specificity with a DDFR value of 0.417 × 10-3 (AUC = 0.710, p = 0.004) as the best cut-off point. In backward stepwise regression analysis, DDRF (OR = 0.72, p = 0.025), gender (OR = 0.76, p = 0.049) and white blood cell count (OR = 1.11, p = 0.373) were modelled (p = 0.029, R2 = 0.577).ConclusionFor diagnosis of PTE, DDFR can be considered to have almost the same importance as D-dimer level. Moreover, it was possible to rule out PTE with only a D-dimer cut-off value < 0.43 mg/dl, without the use of DDFR. However, these values cannot be used as a replacement for angiography or CT angiography

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Hematological Issues in Critically Ill Patients with Cancer

Cited by 16 publications

References 111 publications

Late Common Iliac Artery Stent Thrombosis in a Patient with Terminal Malignancy

Late Common Iliac Artery Stent Thrombosis in a Patient with Terminal Malignancy

Oncologic emergencies in critical care

Accuracy of D-dimer : fibrinogen ratio to diagnose pulmonary thromboembolism in patients admitted to intensive care units : cardiovascular topic

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