Venous gangrene and cancer: A cool look at a burning issue

Abstract

Venous gangrene (VG) is defined as a clinical triad of skin necrosis and discolouration, documented evidence of venous thromboembolism (VTE) and presence of palpable or doppler-identifiable arterial pulsation. Venous gangrene is rare condition which is associated with poor prognosis in cancer patients. The pathogenesis of VG is multifactorial and could paradoxically be due to warfarin treatment. Heparin Induced Thrombocytopenia (HIT) associated venous gangrene develops when heparin therapy is discontinued and warfarin therapy initiated or continued.It has been reported that the presence of anticardiolipin antibodies appears to double the risk of thrombo-embolic events in cancer patients in comparison with those who are anticardiolipin antibody negative. The presence of anticardiolipin antibodies is therefore a warning sign for venous gangrene in cancer patients. Hypercoagulable state associated with malignancy, cancer treatment, prolonged immobilisation, surgical operations and metabolic syndrome are all associated with increased risk of VTE and VG.The current evidence suggests that cancer patients are at increased risk from recurrent venous thrombosis and venous gangrene, and LMWH provides potential promise as a safe and effective measure in the management of such patients.

Ovarian malignancy unmasked by venous gangrene in a patient on warfarin therapy: a case report

“…In these patients there is direct activation of their clotting system by cancer cells, and indirectly by activation of platelets, monocytes and endothelial cells. Cytokines such as tumor necrosis factor-α and interleukin-1β released by tumor cells activate the tissue factor (TF) [ 2 ].…”

“…It was found that a supratherapeutic INR (≥6.0), warfarin-induced PC and protein S deficiency, obesity, and metabolic syndrome were among several factors to predispose to venous thrombosis and gangrene in patients with cancer [ 2 ].…”

“…Venous gangrene complicating deep vein thrombosis (DVT) in the context of anticoagulation use in patients with gynecological malignancy is rarely reported [ 1 ]. The diagnosis can be delayed if not suspected due to its rare occurrence and invariably result in a fatal outcome [ 2 ]. This case report documents a 53-year-old woman who developed bilateral lower limb DVT while being on a therapeutic dose of warfarin for atrial fibrillation (AF) which rapidly progressed to venous gangrene of both feet and subsequently was discovered to have ovarian cancer.…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…In advanced cases, it is marked by severe venous hypertension with collateral and microvascular thrombosis, leading to venous gangrene. Venous gangrene is particularly associated with warfarin-mediated protein C depletion in patients with cancer or heparin-induced thrombocytopenia [ 8 , 9 ].…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…In advanced cases, it is marked by severe venous hypertension with collateral and microvascular thrombosis, leading to venous gangrene. Venous gangrene is particularly associated with warfarinmediated protein C depletion in patients with cancer or heparin-induced thrombocytopenia [8,9].…”