Cisplatin Induced Localized Aortic Thrombus

Acute Aortic Thrombosis in Patients Receiving Cisplatin-Based Chemotherapy

“…Our findings suggest an increased risk of spontaneous thrombosis of the aorta even in patients with no underlying vascular disease or other risk factors, a hypothesis that is corroborated by 3 other cases described in the literature 7,9,11 . Importantly, as in the cases described here, symptoms may be absent or minimal.…”

“…Importantly, as in the cases described here, symptoms may be absent or minimal. Interestingly, events tended to occur later in the treatment course, which varies from the descriptions in previous reports 5,7,9,11 . The patient reported by Morlese et al 9 presented with an acute symptomatic thrombus in a non-atheromatous abdominal aorta, and a separate thrombus in the left ventricle 24 hours after cisplatin infusion for treatment of esophageal adenocarcinoma.…”

“…The mechanism by which cisplatin triggers vascular events is unknown, but endothelial damage seems to play a major role. Other proposed hypotheses are cisplatin-induced elevation of plasma levels of von Willebrand factor and drug-induced reduction of left ventricular function 4,5,7,8 . Cisplatin is known to cause hypomagnesemia, which has been implicated in vascular events.…”

“…In fact, most cases of cisplatin-induced arterial thrombosis described in the literature occurred in patients with at least one of the foregoing risk factors 4,5,7,8 . None of the 4 patients described here had clinical evidence of significant peripheral vascular disease, and ct imaging demonstrated no chronic abnormalities in the abdominal aorta, such as aneurysm or atherosclerotic disease, nor enlarged lymph nodes or tumoural masses causing extrinsic compression of the abdominal aorta.…”

“…The patient reported by Morlese et al 9 presented with an acute symptomatic thrombus in a non-atheromatous abdominal aorta, and a separate thrombus in the left ventricle 24 hours after cisplatin infusion for treatment of esophageal adenocarcinoma. The patient described by Apiyasawat et al 7 presented with symptomatic thrombosis of the aortic arch 5 days after treatment with cisplatin for cervical cancer. Her aorta was noted as non-atheromatous at surgery and pathology specimen.…”