1
|
Rønnow Sand J, Troelsen FS, Nagy D, Farkas DK, Erichsen R, Christiansen CF, Sørensen HT. Increased Cancer Risk in Patients with Kidney Disease and Venous Thromboembolism: A Population-Based Cohort Study. Thromb Haemost 2023; 123:1165-1176. [PMID: 36574778 DOI: 10.1055/s-0042-1759879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) may be a harbinger of cancer in the general population. Patients with kidney disease have an a priori increased VTE risk. However, it remains unknown how a VTE affects subsequent cancer risk in these patients. OBJECTIVES To examine the cancer risk in patients with kidney disease following a VTE. METHODS We conducted a nationwide population-based cohort study in Denmark (1996-2017), including all VTE patients with a diagnosis of kidney disease. We calculated absolute risks of cancer (accounting for competing risk of death) and age-, sex-, and calendar-period standardized incidence ratios (SIRs) comparing the observed cancer incidence with national cancer incidence rates and cancer incidence rates of VTE patients without kidney disease. RESULTS We followed 3,362 VTE patients with kidney disease (45.9% females) for a median follow-up time of 2.4 years (interquartile range: 0.6-5.4). During follow-up, 464 patients were diagnosed with cancer, of whom 169 (36.4%) were diagnosed within the first year. The 1-year absolute risk of any cancer was 5.0% (95% confidence interval [CI]: 4.3-5.8), with a SIR of 2.9 (95% CI: 2.5-3.4) when compared with the general population, and 2.0 (95% CI: 1.8-2.4) when compared with VTE patients without kidney disease. During subsequent years of follow-up, the SIRs declined to 1.5 (95% CI: 1.3-1.6) when compared with the general population, and 1.1 (95% CI: 0.9-1.2) compared with VTE patients without kidney disease. CONCLUSION Patients with hospital-diagnosed kidney disease have increased cancer risk after VTE, especially within the first year following the VTE diagnosis.
Collapse
Affiliation(s)
- Jakob Rønnow Sand
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| | - Frederikke Schønfeldt Troelsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| | - Dávid Nagy
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
- Department of Surgery, Randers Regional Hospital, Randers NØ, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Clinical Institute of Arhus University, Aarhus N, Denmark
| |
Collapse
|
2
|
Malik RA, Liao P, Zhou J, Hussain R, Fredenburgh JC, Hettrick L, Revenko AS, Weitz JI. Histidine-rich glycoprotein attenuates catheter thrombosis. Blood Adv 2023; 7:5651-5660. [PMID: 37042966 PMCID: PMC10546346 DOI: 10.1182/bloodadvances.2022009236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/13/2023] Open
Abstract
Factor XII (FXII) knockdown attenuates catheter thrombosis in rabbits. Because histidine-rich glycoprotein (HRG) modulates FXIIa activity, we hypothesized that HRG depletion would promote catheter thrombosis. To test this, rabbits were given either antisense oligonucleotides (ASOs) against HRG or FXII, a control ASO, or saline. The activated partial thromboplastin time (aPTT), prothrombin time (PT), and catheter-induced thrombin generation were determined in blood collected before and after treatment. Compared with the controls, the HRG- and FXII-directed ASOs reduced hepatic messenger RNA and plasma levels of HRG and FXII, respectively, by >90%. Although HRG knockdown shortened the aPTT by 2.5 fold, FXII knockdown prolonged it by fourfold; neither of the ASOs affected the PT. Catheter segments shortened the lag time and increased peak thrombin in the plasma from control rabbits; effects were significantly enhanced and attenuated in the plasma from rabbits given the HRG- and FXII-directed ASOs, respectively. Catheters were then inserted into the right external jugular vein of the rabbits, and the time for catheter occlusion was determined. The catheter occlusion times with the control ASO or saline were 62 ± 8 minutes and 60 ± 11 minutes, respectively. The occlusion time was significantly reduced to 34 ± 9 minutes, with HRG knockdown and significantly prolonged to 128 ± 19 minutes with FXII knockdown. HRG levels are decreased with sepsis or cancer, and such patients are prone to catheter thrombosis. Because HRG modulates catheter thrombosis, our findings suggest that HRG supplementation may prevent this problem.
Collapse
Affiliation(s)
- Rida A. Malik
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Peng Liao
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ji Zhou
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rawaa Hussain
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - James C. Fredenburgh
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa Hettrick
- Department of Pulmonary and Oncology Drug Discovery, Ionis Pharmaceuticals Inc, Carlsbad, CA
| | - Alexey S. Revenko
- Department of Pulmonary and Oncology Drug Discovery, Ionis Pharmaceuticals Inc, Carlsbad, CA
| | - Jeffrey I. Weitz
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
3
|
Napolitano M, Siragusa S. The Role of Injectables in the Treatment and Prevention of Cancer-Associated Thrombosis. Cancers (Basel) 2023; 15:4640. [PMID: 37760609 PMCID: PMC10526875 DOI: 10.3390/cancers15184640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of death among patients with cancer. CAT can manifest itself as venous thromboembolism (VTE), in the form of deep vein thrombosis or pulmonary embolism, or arterial thromboembolism. The pathophysiology of CAT is complex and depends on cancer-, patient-, treatment- and biomarkers-related factors. Treatment of VTE in patients with cancer is complex and includes three major classes of anticoagulant agents: heparin and its derivatives, e.g., low molecular weight heparins, direct oral anticoagulants (DOACs), and vitamin K inhibitors. Given the tremendous heterogeneity of clinical situations in patients with cancer and the challenges of CAT, there is no single universal treatment option for patients suffering from or at risk of CAT. Initial studies suggested that patients seemed to prefer an anticoagulant that would not interfere with their cancer treatment, suggesting the primacy of cancer over VTE, and favoring efficacy and safety over convenience of route of administration. Recent studies show that when the efficacy and safety aspects are similar, patients prefer the oral route of administration. Despite this, injectables are a valid option for many patients with cancer.
Collapse
Affiliation(s)
- Mariasanta Napolitano
- Haematology Unit, Thrombosis and Haemostasis Reference Regional Center, University of Palermo, 90121 Palermo, Italy;
| | | |
Collapse
|
4
|
Glombik D, Davidsson S, Sandin F, Lambe M, Carlsson J, Sundqvist P, Kirrander P. Penile cancer: long-term infectious and thromboembolic complications following lymph node dissection - a population-based study (Sweden). Acta Oncol 2023:1-7. [PMID: 37130005 DOI: 10.1080/0284186x.2023.2206524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To assess the long-term risks of infectious and thromboembolic events following inguinal (ILND) and pelvic (PLND) lymph node dissection in men with penile cancer. MATERIAL AND METHODS A total of 364 men subjected to ILND with or without PLND for penile cancer between 2000 and 2012 were identified in the Swedish National Penile Cancer Register. Each patient was matched based on age and county of residence with six penile cancer-free men. The Swedish Cancer Register and other population-based registers were used to retrieve information on treatment and hospitalisation for selected infectious and thromboembolic events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with multiple imputation. RESULTS The risk of infectious events remained increased for more than five years postoperatively in men with penile cancer compared with matched controls. The palpable nodal disease was the only predictor of these events, with risk increasing with the cN stage. The HR at one, three and five years and six months postoperatively was 8.60 (95% CI 5.16-14.34), 4.02 (95% CI 2.65-6.09) and 1.93 (95% CI 1.11-3.38), respectively. An increased risk of thromboembolic events persisted for three years postoperatively. The HR at one and three years postoperatively was 13.51 (95% CI 6.53-27.93) and 2.12 (95% CI 1.07-4.20). The results correspond well with the over-prescription of anticoagulants observed during this period. An association with bulky disease (cN3) was observed. CONCLUSIONS Lymph node dissection for penile cancer is associated with an increased risk of infectious and thromboembolic events. The findings of this population-based study show that the risks of these events remain increased more than five years for infectious and three years for thromboembolic events. Improved awareness of long-term complications following ILND is of importance both among patients and care givers to ensure early detection and treatment.
Collapse
Affiliation(s)
- Dominik Glombik
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Mats Lambe
- Regional Cancer Centre Central-Sweden, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter Kirrander
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
5
|
Zeman J, Kompella R, Lee J, Kim AS. Case report: Non-thrombotic iliac vein lesion: an unusual cause of unilateral leg swelling in a patient with endometrial carcinoma. Front Cardiovasc Med 2023; 10:1115870. [PMID: 37200980 PMCID: PMC10185828 DOI: 10.3389/fcvm.2023.1115870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
81-year-old female presented with subacute right lower extremity edema due to iliac vein compression by a markedly enlarged external iliac lymph node later identified as newly relapsed metastatic endometrial carcinoma. The patient underwent a full evaluation of the iliac vein lesion and cancer and had an intravenous stent placed with complete resolution of symptoms post-procedure.
Collapse
Affiliation(s)
- Jan Zeman
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Ritika Kompella
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - JuYong Lee
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, United States
| | - Agnes S. Kim
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States
- Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, United States
- Correspondence: Agnes S. Kim
| |
Collapse
|
6
|
Brenner B, Ay C, Gal GL, Carrier M, Muñoz AJ, Agnelli G, Rocha ATC, Abdel-Razeq H, Elalamy I, Falanga A. Venous thromboembolism risk, prophylaxis and management in cancer patients with COVID-19: An unmet medical need. THROMBOSIS UPDATE 2022; 6:100098. [PMID: 38620707 PMCID: PMC8743273 DOI: 10.1016/j.tru.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the second leading cause of morbidity and mortality in these patients. The implementation of lockdowns following the COVID-19 pandemic has resulted in decreased mobility and delayed access to care, thus further increasing the susceptibility to VTE. Cancer patients may also be at a higher risk of SARS-CoV-2 infection and have been shown to be more likely to experience severe COVID-19 disease compared to patients without cancer. Given that both cancer and COVID-19 exhibit a hypercoagulable state, stasis of blood flow, and endothelial injury, cancer patients with COVID-19 constitute a vulnerable population with a high risk of thrombosis and bleeding. However, to date there are limited studies evaluating whether cancer patients infected with SARS-CoV-2 have a higher VTE incidence than COVID-19 patients without cancer, how to assess the risk of VTE, prophylaxis and treatment in this special population. Herein, we highlight the urgent need for studies in cancer patients with COVID-19 to ensure appropriate patient care and improve clinical outcomes.
Collapse
Affiliation(s)
- Benjamin Brenner
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Vienna, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrés J Muñoz
- Medical Oncology Department. Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Ana Thereza Cavalcanti Rocha
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia, Departamento de Saúde da FamíliaSalvador, BA, Brazil
| | | | - Ismail Elalamy
- Hematology and Thrombosis Centre, Hôpital Tenon, INSERM U938, Sorbonne Université, AP-HP, Paris, France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Anna Falanga
- University of Milano-Bicocca, School of Medicine, Monza, Italy
- Department of Immunohematology and Transfusion Medicine, Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
7
|
Perry Y. Commentary: Venous embolic events after lung resection: How does it affect prognosis? What are recommendations to prevent it? JTCVS OPEN 2021; 6:248-249. [PMID: 36003570 PMCID: PMC9390724 DOI: 10.1016/j.xjon.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yaron Perry
- Address for reprints: Yaron Perry, MD, FACS, Division Chief of Thoracic Surgery and Thoracic Oncology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St, C-313, Buffalo, NY 14203.
| |
Collapse
|
8
|
Boey T, Sule AA, Sule AA. Successful Treatment of Recurrent Thrombosis Associated with Malignancy with Apixaban and Follow-up for 1 Year. Int J Angiol 2020; 29:256-259. [PMID: 33268977 DOI: 10.1055/s-0039-1694780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This case report aims to highlight a successful example of using novel oral anticoagulants (NOACs), such as apixaban, to prevent recurrent venous thromboembolism (VTE) in patients with solid-organ malignancy, as an alternative to low-molecular weight heparin (LMWH). Discussed is the case of a 67-year-old woman diagnosed with recurrent thrombosis in the upper-right limb and malignancy of right breast with metastasis to the axillary lymph nodes. Over a follow-up period of more than 1 year, there was no recurrence of VTE and D-dimer decreased, illuminating the possibility of apixaban as an alternative form of treatment for recurrent VTE in patients with malignancy. This appears to be one of the first case reports in Singapore.
Collapse
Affiliation(s)
| | | | - Ashish Anil Sule
- Department of General Medicine, Vascular Medicine and Hypertension, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
9
|
Lichota A, Szewczyk EM, Gwozdzinski K. Factors Affecting the Formation and Treatment of Thrombosis by Natural and Synthetic Compounds. Int J Mol Sci 2020; 21:E7975. [PMID: 33121005 PMCID: PMC7663413 DOI: 10.3390/ijms21217975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT), whose consequence may be a pulmonary embolism (PE). Thrombosis is associated with significant morbidity and mortality and is the third most common cardiovascular disease after myocardial infarction and stroke. DVT is associated with the formation of a blood clot in a deep vein in the body. Thrombosis promotes slowed blood flow, hypoxia, cell activation, and the associated release of many active substances involved in blood clot formation. All thrombi which adhere to endothelium consist of fibrin, platelets, and trapped red and white blood cells. In this review, we summarise the impact of various factors affecting haemostatic disorders leading to blood clot formation. The paper discusses the causes of thrombosis, the mechanism of blood clot formation, and factors such as hypoxia, the involvement of endothelial cells (ECs), and the activation of platelets and neutrophils along with the effects of bacteria and reactive oxygen species (ROS). Mechanisms related to the action of anticoagulants affecting coagulation factors including antiplatelet drugs have also been discussed. However, many aspects related to the pathogenesis of thrombosis still need to be clarified. A review of the drugs used to treat and prevent thrombosis and natural anticoagulants that occur in the plant world and are traditionally used in Far Eastern medicine has also been carried out.
Collapse
Affiliation(s)
- Anna Lichota
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Eligia M. Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Krzysztof Gwozdzinski
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
| |
Collapse
|
10
|
Citro R, Prota C, Resciniti E, Radano I, Posteraro A, Fava A, Monte IP. Thrombotic Risk in Cancer Patients: Diagnosis and Management of Venous Thromboembolism. J Cardiovasc Echogr 2020; 30:S38-S44. [PMID: 32566465 PMCID: PMC7293865 DOI: 10.4103/jcecho.jcecho_63_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022] Open
Abstract
Venous thromboembolism (VTE) represents a major health problem, especially in cancer patients, who experience a significantly higher incidence of both deep vein thrombosis and pulmonary embolism compared to the general population. Indeed, patients with cancer have a prothrombotic state resulting in both increased expression of procoagulants and suppression of fibrinolytic activity. In addition, VTE increases the morbidity and mortality of these patients. For all these reasons, the prevention and treatment of VTE in cancer setting represent major challenges in daily practice. In general, low-molecular-weight heparin monotherapy is the standard of care for the management of cancer-associated VTE, as Vitamin K antagonists are less effective in this setting. Direct oral anticoagulants offer a potentially promising treatment option for cancer patients with VTE, since recent studies demonstrated their efficacy and safety also in this peculiar setting.
Collapse
Affiliation(s)
- Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
| | - Costantina Prota
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
| | | | - Ilaria Radano
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
| | | | - Antonella Fava
- Cardiology Department, University Hospital “Città della Salute e della Scienza di Torino”, Molinette Hospital, Turin, Italy
| | - Ines Paola Monte
- Cardiology Department Echocardiography Laboratory, Department of Cardiothoracic and Vascular, Policlinico “Vittorio Emanuele”, Catania University, Catania, Italy
| |
Collapse
|
11
|
Kim J, Kim HJ, Park S, Kim DK, Kim TH. Predictive Factors of Deep Vein Thrombosis in Gynecologic Cancer Survivors with Lower Extremity Edema: A Single-Center and Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8010048. [PMID: 32120824 PMCID: PMC7151164 DOI: 10.3390/healthcare8010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL.
Collapse
Affiliation(s)
- Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Hyun-Jun Kim
- Department of Obstetrics & Gynecology, School of Medicine, Konkuk University, Chungju 27478, Korea;
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Seunghun Park
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Dong Kyu Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
- Correspondence: ; Tel.: +82-43-840-8890; Fax: +82-43-840-8968
| |
Collapse
|
12
|
Fresard ME, Erices R, Bravo ML, Cuello M, Owen GI, Ibanez C, Rodriguez-Fernandez M. Multi-Objective Optimization for Personalized Prediction of Venous Thromboembolism in Ovarian Cancer Patients. IEEE J Biomed Health Inform 2019; 24:1500-1508. [PMID: 31562113 DOI: 10.1109/jbhi.2019.2943499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thrombotic events are one of the leading causes of mortality and morbidity related to cancer, with ovarian cancer having one of the highest incidence rates. The need to prevent these events through the prescription of adequate schemes of antithrombotic prophylaxis has motivated the development of models that aid the identification of patients at higher risk of thrombotic events with lethal consequences. However, antithrombotic prophylaxis increases the risk of bleeding and this risk depends on the class and intensity of the chosen antithrombotic prophylactic scheme, the clinical and personal condition of the patient and the disease characteristics. Moreover, the datasets used to obtain current models are imbalanced, i.e., they incorporate more patients who did not suffer thrombotic events than patients who experienced them what can lead to wrong predictions, especially for the clinically relevant patient group at high risk of thrombosis. Herein, predictive models based on machine learning were developed utilizing 121 high-grade serous ovarian carcinoma patients, considering the clinical variables of the patients and those typical of the disease. To properly manage the data imbalance, cost-sensitive classification together with multi-objective optimization was performed considering different combinations of metrics. In this way, five Pareto fronts and a series of optimal models with different false positive and false negative rates were obtained. With this novel approach to the development of clinical predictive models, personalized models can be developed, helping the clinician to achieve a better balance between the risk of bleeding and the risk of thrombosis.
Collapse
|
13
|
Ruff SM, Ayabe RI, Wach MM, Diggs LP, Martin SP, Davis JL, Hernandez JM. Practice patterns of VTE chemoprophylaxis after discharge following hepatic and pancreatic resections for cancer: A survey of hepatopancreatobiliary surgeons. J Thromb Thrombolysis 2019; 48:119-124. [PMID: 30877618 PMCID: PMC6595222 DOI: 10.1007/s11239-019-01834-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with hepatopancreatobiliary (HPB) malignancies undergoing resection are prone to venous thromboembolism (VTE), and current guidelines recommend up to 28 days of chemoprophylaxis after major surgery. We sought to determine the practice patterns among HPB surgeons for use of chemoprophylaxis after discharge. A survey on VTE chemoprophylaxis after oncologic HPB operations was distributed to attending surgeons at the 18 HPB fellowship training programs in the United States and Canada. Of the HPB surgeons surveyed, 44 (44%) responded. VTE prophylaxis is used by 93% of respondants in the inpatient postoperative setting. Chemoprophylaxis after discharge for pancreaticoduodenenctomy and distal pancreatectomy is utilized by 45% and 39% of respondants, respectively. Of those who prescribe chemoprophylaxis after discharge, 79% and 88% prescribe it for the recommended 28 days after pancreaticoduodenectomy and distal pancreatectomy, respectively. Chemoprophylaxis after discharge for major and minor hepatectomy is utilized by 39% and 26% of respondents, respectively. Of those who prescribe chemoprophylaxis after discharge, 67% and 55% provide it for the recommended 28 days after major and minor hepatectomy, respectively. Despite documented prolonged postoperative thrombogenic risk, the use of chemoprophylaxis following discharge after pancreatic and liver resections for cancer was moderate among surveyed HPB surgeons.
Collapse
Affiliation(s)
- Samantha M Ruff
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Reed I Ayabe
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Michael M Wach
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Laurence P Diggs
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Sean P Martin
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Jeremy L Davis
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA
| | - Jonathan M Hernandez
- National Institutes of Health, 10 Center Drive, Room 4W-3740, Bethesda, MD, 20892, USA.
| |
Collapse
|
14
|
Tandon V, Kethireddy N, Balakumaran K, Kim AS. Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5416185. [PMID: 31449588 PMCID: PMC6601241 DOI: 10.1093/ehjcr/ytz029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/27/2019] [Indexed: 01/07/2023]
Abstract
Background Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG). Case summary A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice. Discussion Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.
Collapse
Affiliation(s)
- Varun Tandon
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Nikhila Kethireddy
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Kathir Balakumaran
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.,Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Agnes S Kim
- Department of Internal Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA.,Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| |
Collapse
|
15
|
Krill T, Baliss M, Zaibaq J, Abdulla HM, Parupudi S. Acute lymphoblastic leukemia presenting with mesenteric ischemia. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2019; 12:370-373. [PMID: 31749927 PMCID: PMC6820834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Malignancy can induce a hypercoagulable state and lead to an increased risk of thromboembolic events. The pathogenesis of the prothrombotic state in cancer is complicated but is thought to involve several mechanisms. Thrombosis predominantly affects the venous circulation and infrequently the arteries. Arterial occlusion as an initial manifestation of acute leukemia is unusual. This is a case of a 44-year-old male admitted with complete thrombotic occlusion of the superior mesenteric artery and treated with emergent thrombectomy. Hematologic work-up was consistent with a diagnosis of T-cell acute lymphoblastic leukemia. To our knowledge, this is the first case of complete occlusion of the superior mesenteric artery presenting as the initial manifestation of T-cell acute lymphoblastic leukemia.
Collapse
Affiliation(s)
- Timothy Krill
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Texas, USA
| | - Michelle Baliss
- Department of Internal Medicine, The University of Texas Medical Branch, Texas, USA
| | - Jenine Zaibaq
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Texas, USA
| | - Hamza M. Abdulla
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Texas, USA
| | - Sreeram Parupudi
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Texas, USA
| |
Collapse
|
16
|
El-Sayed Shaat AS, Zaid N, Abd El-Haleem M. Recent trends in the management of deep vein thrombosis in cancer patients. MENOUFIA MEDICAL JOURNAL 2019; 32:1328. [DOI: 10.4103/mmj.mmj_407_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
17
|
Ruff SM, Weber KT, Khader A, Conte C, Kadison A, Sullivan J, Wang J, Zaidi R, Deutsch GB. Venous thromboembolism in patients with cancer undergoing surgical exploration. J Thromb Thrombolysis 2018; 47:316-323. [DOI: 10.1007/s11239-018-1774-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Cohen AT, Maraveyas A, Beyer-Westendorf J, Lee AYY, Mantovani LG, Bach M. COSIMO - patients with active cancer changing to rivaroxaban for the treatment and prevention of recurrent venous thromboembolism: a non-interventional study. Thromb J 2018; 16:21. [PMID: 30186045 PMCID: PMC6122180 DOI: 10.1186/s12959-018-0176-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Around 20% of venous thromboembolism (VTE) cases occur in patients with cancer. Current guidelines recommend low molecular weight heparin (LMWH) as the preferred anticoagulant for VTE treatment. However, some guidelines state that vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are acceptable alternatives for long-term therapy in some patients if LMWHs are not available. LMWHs and VKAs have a number of drawbacks that can increase the burden on patients. DOACs, such as rivaroxaban, can ameliorate some burdens and may offer an opportunity to increase patient satisfaction and health-related quality of life (HRQoL). The Cancer-associated thrOmboSIs - patient-reported outcoMes with rivarOxaban (COSIMO) study is designed to provide real-world information on treatment satisfaction in patients with active cancer who switch from LMWH or VKA to rivaroxaban for the treatment of acute VTE or to prevent recurrent VTE. METHODS COSIMO is a prospective, non-interventional, single-arm cohort study that aims to recruit 500 patients in Europe, Canada and Australia. Adults with active cancer who are switching to rivaroxaban having received LMWH/VKA for the treatment and secondary prevention of recurrent VTE for at least the previous 4 weeks are eligible. Patients will be followed for 6 months. The primary outcome is treatment satisfaction assessed as change in the Anti-Clot Treatment Scale (ACTS) Burdens score at week 4 after enrolment compared with baseline. Secondary outcomes include treatment preferences, measured using a discrete choice experiment, change in ACTS Burdens score at months 3 and 6, and change in HRQoL (assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue questionnaire). COSIMO will collect data on patients' medical history, patterns of anticoagulant use and incidence of bleeding and thromboembolic events. Study recruitment started in autumn 2016. CONCLUSIONS COSIMO will provide information on outcomes associated with switching from LMWH or VKA therapy to rivaroxaban for the treatment or secondary prevention of cancer-associated thrombosis in a real-life setting. The key goal is to assess whether there is a change in patient-reported treatment satisfaction. In addition, COSIMO will facilitate the evaluation of the safety and effectiveness of rivaroxaban in preventing recurrent VTE in this patient population. TRIAL REGISTRATION NCT02742623. Registered 19 April 2016.
Collapse
Affiliation(s)
- Alexander T. Cohen
- Department of Haematological Medicine, Guys and St Thomas’ NHS Foundation Trust, King’s College London, Westminster Bridge Road, London, UK
| | - Anthony Maraveyas
- Joint Centre for Cancer Studies, Hull York Medical School, QCOH, Castle Hill Hospital, Hull, UK
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany
- Kings Thrombosis Service, Department of Haematology, Kings College London, London, UK
| | - Agnes Y. Y. Lee
- Division of Hematology, University of British Columbia, British Columbia Cancer Agency, Vancouver, BC Canada
| | - Lorenzo G. Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | | |
Collapse
|
19
|
Muñoz Martín AJ, Ortega I, Font C, Pachón V, Castellón V, Martínez-Marín V, Salgado M, Martínez E, Calzas J, Rupérez A, Souto JC, Martín M, Salas E, Soria JM. Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer. Br J Cancer 2018; 118:1056-1061. [PMID: 29588512 PMCID: PMC5931103 DOI: 10.1038/s41416-018-0027-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a leading cause of death among patients with cancer. Outpatients with cancer should be periodically assessed for VTE risk, for which the Khorana score is commonly recommended. However, it has been questioned whether this tool is sufficiently accurate at identifying patients who should receive thromboprophylaxis. The present work proposes a new index, TiC-Onco risk score to be calculated at the time of diagnosis of cancer, that examines patients' clinical and genetic risk factors for thrombosis. METHODS We included 391 outpatients with a recent diagnosis of cancer and candidates for systemic outpatient chemotherapy. All were treated according to standard guidelines. The study population was monitored for 6 months, and VTEs were recorded. The Khorana and the TiC-Onco scores were calculated for each patient and their VTE predictive accuracy VTEs was compared. RESULTS We recorded 71 VTEs. The TiC-Onco risk score was significantly better at predicting VTE than the Khorana score (AUC 0.73 vs. 0.58, sensitivity 49 vs. 22%, specificity 81 vs. 82%, PPV 37 vs. 22%, and NPV 88 vs. 82%). CONCLUSIONS TiC-Onco risk score performed significantly better than Khorana score at identifying cancer patients at high risk of VTE who would benefit from personalised thromboprophylaxis.
Collapse
Affiliation(s)
- Andrés J Muñoz Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain.
| | - Israel Ortega
- Scientific Department, Gendiag, Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - Carme Font
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Clínic, c/ Villarroel, 170, 08036, Barcelona, Spain
| | - Vanesa Pachón
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario Ramón y Cajal Madrid, Ctra. Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
| | - Victoria Castellón
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Complejo Hospitalario de Torrecárdenas, c/ Hermandad de Donantes de Sangre, 04009, Almería, Spain
| | - Virginia Martínez-Marín
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Mercedes Salgado
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Complejo Hospitalario Universitario de Ourense, c/ Ramon Puga Noguerol, 54, 32005, Ourense, Spain
| | - Eva Martínez
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008, Santander, Spain
| | - Julia Calzas
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Madrid, Spain
| | - Ana Rupérez
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
- Medical Oncology, Fundación Jiménez Díaz, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Juan C Souto
- Thrombosis and Haemostasia, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
- Cancer & Thrombosis Working Group, Spanish Society of Medical Oncology (SEOM), C/ de Velázquez, 7, 28001, Madrid, Spain
| | - Eduardo Salas
- Scientific Department, Gendiag, Joan XXIII, 10, 08950, Esplugues de Llobregat, Spain
| | - Jose M Soria
- Genomic of complex diseases, Institut d'Investigació Sant Pau (IIB-Sant Pau), Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| |
Collapse
|
20
|
Caprini Risk Model Decreases Venous Thromboembolism Rates in Thoracic Surgery Cancer Patients. Ann Thorac Surg 2018; 105:879-885. [DOI: 10.1016/j.athoracsur.2017.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 01/27/2023]
|
21
|
Repetto O, De Re V. Coagulation and fibrinolysis in gastric cancer. Ann N Y Acad Sci 2017; 1404:27-48. [PMID: 28833193 DOI: 10.1111/nyas.13454] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/12/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022]
Abstract
Coagulation is a highly conserved process occurring after an injury to a blood vessel and resulting in hemostasis. In the thrombus microenvironment, finely orchestrated events restore vessel integrity through platelet activation, adhesion, and aggregation (primary hemostasis), followed by the coagulation cascades, thrombin generation, and fibrin clot deposition (secondary hemostasis). Several studies on cancer have provided insight into dramatic changes to coagulation-related events (i.e., fibrin clot deposition, fibrinolysis) during tumor pathogenesis, progression, and metastasis, in addition to a tumor-driven systemic activation of hemostasis and thrombosis (Trousseau's syndrome). Diverse molecular and cellular effectors participate in the cross talk between hemostasis and tumors. Here, we focus on some aspects of the interconnection between cancer biology and hemostatic components, with particular attention to some key coagulation-related proteins (e.g., tissue factor, thrombin, fibrinogen, and D-dimers) in the particular case of gastric cancer (GC). Recent advances in deciphering the complex molecular link between GC and the coagulation system are described, showing their important roles in better management of patients affected by GC.
Collapse
Affiliation(s)
- Ombretta Repetto
- Facility of Bio-Proteomics, Immunopathology and Cancer Biomarkers, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Valli De Re
- Facility of Bio-Proteomics, Immunopathology and Cancer Biomarkers, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| |
Collapse
|