The pathogenesis of venous thromboembolism in cancer: emerging links with tumour biology

Abstract

Venous thromboembolism (VTE) is a frequent complication in individuals with cancer and is considered to be a cause of substantial mortality. Epidemiological studies identify malignancy as an independent VTE risk factor and show that cancer patients are at increased risk of both initial and recurrent VTE events. The risk due to cancer is compounded by the effects of chemotherapy and other treatments. The pathogenesis of cancer-associated VTE is complex involving multiple interactions between tumours and various components of haemostasis. The development of a systemic hypercoagulable state is considered a key pathogenetic feature and is attributed to tumour expression of tissue factor and other procoagulants, activation of vascular cells by tumour-derived cytokines and adhesive interactions between tumour cells and host cells. An increasing body of evidence indicates that the activation of haemostasis in malignant disease contributes to tumour growth and progression by stimulation of intracellular signalling pathways. The interaction of tissue factor, thrombin and other coagulation factors with protease activated receptor (PAR) proteins expressed by tumour cells and host vascular cells leads to the induction of genes related to the processes of angiogenesis, cell survival and cell adhesion and migration.

Peptides in Low Molecular Weight Fraction of Serum Associated with Hepatocellular Carcinoma

“…Our study was conducted in serum; however, we still observed the ladder of peptides derived from fibrinogen α when we analyzed EDTA plasma from disease free controls. Cancer is known to be associated with disorders of hemostasis and it is still unclear how much fragmentation occurs in vivo and what are the functional implications [46][47][48][49][50].…”

Trousseau's syndrome: multiple definitions and multiple mechanisms

“…Despite its frequent mention in reviews, [4][5][6][7][8][9][10][11][12][13][14][15][16][17] the term Trousseau's syndrome is not in the MeSH headings of Medline or PubMed. Literature searching is confounded by the insistence of some journal editors on using "Trousseau syndrome."…”

“…[30][31][32] Such findings suggested that activators of fluid-phase coagulation were the key to the pathogenesis. [9][10][11][12][13][14][15][16][17] This review concludes that Trousseau's syndrome is actually a spectrum of disorders and considers additional molecular mechanisms that have more recently pointed to pathways for its initiation. This is done recognizing how little we still understand about this syndrome, and yet how important it is to seek a better understanding of it.…”

Potential Antithrombotic Effects of Bupivacaine in Malignancies: An In Vitro Assesment Using Thromboelastography

“…The association between malignancy and thrombosis has been reported in many studies [1,2] . Cancer cells activate the hemostatic system by producing molecules with procoagulant, fibrinolytic or proaggregating activities.…”