Arterial events in cancer patients—the case of acute coronary thrombosis

Abstract

Patients with cancer are at high risk for both venous and arterial thrombotic complications. A variety of factors account for the greater thrombotic risk, including the underlying malignancy and numerous cancer-directed therapies. The occurrence of an acute thrombotic event in patients with cancer is associated with substantial morbidity and mortality. Acute coronary syndrome (ACS) represents a particularly important cardiovascular complication in cancer patients. With cardio-vascular risk factors becoming more prevalent in an aging cancer population that is surviving longer, questions pertaining to the appropriate management of vascular toxicity are likely to assume even greater value in the coming years. In this article, we review the current understanding of ACS in patients with cancer. The predisposition to thrombosis in a malignant host and the cancer treatments most commonly associated with vascular toxicity are reviewed. Risk prediction and management strategies are discussed, and discrepancies in the clinical evidence are highlighted.

Acute Coronary Artery Thrombosis in a Patient With Non-Small Cell Lung Cancer

“…Therefore, treating cancer-induced coronary thrombosis remains challenging. Previous studies reported that anticoagulation and antiplatelet therapy is key in acute coronary thrombosis without any underlying atherosclerotic plaque [7]. In our case, no stent implantation, balloon dilatation, or thromboaspiration were performed.…”

“…The relationship between the type of cancer and thrombosis is conflicting. An analysis conducted by Oren and Herrmann showed that cancer types highly accompanied with an increased risk of arterial thromboembolism encompassed lung [hazard ratio (HR) 9.6], pancreas (HR 6.8), colorectal (HR 6.7), and gastric cancer (HR 6.0) [7]. Additional data analysis indicated a greater prevalence of arterial thromboembolic incidents in the first six months from the time of cancer diagnosis [8].…”

Human Induced Pluripotent Stem Cells as a Screening Platform for Drug-Induced Vascular Toxicity

“…First, there is a lack of specific circulating biomarkers for early vascular injuries in humans ( Louden et al, 2006 ; Mikaelian et al, 2014 ). Second, vascular susceptibility to drugs is patient-specific, depending on numerous pre-existing conditions of an individual ( Oren and Herrmann, 2018 ). Lastly, the mode of injury varies significantly from drug to drug ( Herrmann, 2020 ).…”

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

“…Cancer disease has been reported to be present in up to 17% of patients with ACS [ 3 , 4 , 7 , 8 ]. Very recent data from 6.5 million patients presenting with an acute myocardial infarction (AMI) between 2004 and 2014, included in the US National Inpatient Sample (NIS) database, showed a prevalence of 9% of patients with cancer [ 3 ]. This figure was composed of 2.8% of patients with current cancer and 6.8% with a historical diagnosis of cancer.…”

“…Moreover, some cancers, as well as some of their therapies, should be themselves considered true cardiovascular risk factors. For these reasons, the occurrence of acute coronary syndrome (ACS) in cancer patients is not uncommon [ 3 , 4 ]. Notably, ACS may develop before or after establishing a diagnosis of cancer; sometimes, the diagnosis is made during hospitalization for ACS and, conversely, in some cases, ACS may occur during hospitalization for active cancer [ 5 ].…”