Coagulopathic complications in breast cancer

Abstract

Patients with cancer are highly susceptible to thromboembolic complications, which account for a significant percentage of the morbidity and mortality of the disease. Up to 15% of patients with clinically overt cancer present with venous thromboembolism during the course of their disease. Moreover, patients with cancer represent 20% of all patients in whom deep venous thrombosis and pulmonary embolism are diagnosed. This prothrombotic state in cancer can occur due to the ability of tumor cells to directly activate the blood-clotting cascade and cause thrombosis or induce procoagulant properties and inhibit anticoagulant properties of vascular endothelial cells, platelets, monocytes, and macrophages. It also is well established that this prothrombotic tendency in patients with cancer can be enhanced greatly by anticancer treatments, such as surgery and chemotherapy. This phenomenon can be seen in patients with breast cancer, particularly after surgery and chemotherapy. Increased clotting risk also is associated with the use of central venous access devices, commonly used to administer chemotherapeutic agents in patients with cancer. Thrombosis prophylaxis, therefore, should be considered for patients with breast cancer who are at risk before and during intervention. In the current review, the authors discuss the problem of thromboembolism in patients with breast cancer who are undergoing therapy, the mechanisms by which thromboembolisms occur, and the potential strategies by which these events may be prevented. Better understanding of these pathogenetic pathways may lead to the development of more targeted strategies to prevent thromboembolism in patients with cancer. Cancer 2003;98:1578 -86.

Thrombin-Activatable Fibrinolysis Inhibitor in Breast Cancer Patients

“…Up to 15% of patients with cancer present with venous thromboembolism during the course of their disease. Approximately 5% of breast cancer patients have thrombotic complications while on chemotherapy [3] . The increased levels of TAFI and fibrinogen found in our study may explain the thrombotic state of breast cancer patients.…”

“…Unfortunately, a large number of these tumors and some treatment modalities are compounded by risks that increase the mortality and morbidity associated with atherosclerotic complications. In patients with malignant disease, induction of coagulation mechanisms causes increased fibrinolytic function, so such patients show a tendency to coagulation and fibrinolytic disorders [3] . Many factors can affect the coagulation system, including thrombocytosis, elevated Ddimer levels or increased tissue factor levels in cancer patients [4] .…”

Multilectin Affinity Chromatography for Characterization of Multiple Glycoprotein Biomarker Candidates in Serum from Breast Cancer Patients

“…Cancer is a complex set of diseases that can lead to systemic changes (20,21 ). Serum proteomic detection of early cancer would be enhanced by the identification of specific metabolic or immunological alterations that do not depend on the presence of notable tumor mass (22 ).…”

Safety of low-dose low-molecular-weight-heparins in thrombocytopenic stem cell transplantation patients: a case series and review of the literature

“…The etiology of these thrombotic events (TE) is multifactorial, and they may occur before, during, or after transplantation. Prior to transplantation, some patients may have developed TE secondary to: active malignancy, [5][6][7] chemotherapy and hormonal treatment for the treatment of adjuvant/metastatic breast cancer, 8 L-asparaginase in ALL, 7 thalidomide in renal cell carcinoma or multiple myeloma 9,10 all-trans-retinoic acid in acute promyelocytic leukemia, 11 coexistent thrombophilia, 12 continuous infusion GM-CSF use in inferior vena cava apheresis catheters, 13 and indwelling catheters. [14][15][16] During transplantation, TE are primarily associated with the use of central venous catheters.…”