“Idiopathic” Deep Venous Thrombosis: The Value of Routine Abdominal and Pelvic Computed Tomographic Scanning

Sannella, Nicholas A.; O’Connor, Daniel

doi:10.1007/bf02329376

Cited by 23 publications

(19 citation statements)

References 14 publications

(10 reference statements)

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“…In patients with VTE, the prevalence of concomitant cancer, defined as cancer not diagnosed before VTE and found by routine investigation, is 4-10% but varies considerably between the studies (0-23.8%) due to differences in threshold of suspicion, screening methods, and characteristics of the patients (e.g. age) [18,19]. In our group of GIAC patients, deep vein thrombosis was confirmed in two cases (4.4%).…”

Section: Discussionmentioning

confidence: 73%

Cancer procoagulant in patients with adenocarcinomas

Kaźmierczak

Lewandowski

Wojtukiewicz

et al. 2005

Blood Coagulation &Amp; Fibrinolysis

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Cancer procoagulant (CP) is a cysteine proteinase that may be produced by malignant and foetal tissue. The possible role of CP in the pathogenesis of cancer-related thrombosis has been suggested recently. The purpose of the study was to evaluate coagulation prothrombotic markers and their relation to CP concentration in the blood of patients with gastrointestinal adenocarcinomas (GIAC). The study group consisted of 45 patients with confirmed diagnosis of adenocarcinoma (stomach, 18 patients; colon, 27 patients) and without evident metastatic disease. In 24 patients further observation showed metastases. The control group for CP was composed of 10 healthy subjects. Blood samples were drawn on the admission day, before any treatment. Among 45 patients with GIAC, deep venous thrombosis was observed in two (4.4%). In all patients the CP activity in the serum was found, and the mean CP activity shortened the coagulation time almost three times compared with the healthy control group. Also, the mean thrombin-antithrombin complex concentration was above the normal range. A significant elevation of the mean prothrombin fragment 1+2 plasma content in this group of patients was noticed. Despite these observations, CP remained within the normal range and did not correlate with thrombin-antithrombin complex or prothrombin fragment 1+2 plasma concentrations. A positive correlation was observed between serum CP and fibrinogen concentration, and a negative correlation between CP and free protein S plasma content (P = 0.04 and P = 0.025, respectively). A negative correlation between activated protein C resistance ratio and protein C activity in the plasma was confirmed. Protein C activity in the plasma showed a correlation with free protein S plasma content. Analysis of factors influencing the activated partial thromboplastin time revealed the presence of antiphospholipid antibodies in seven persons from the study group (in three cases of IgG and in four cases of IgM class). Our data suggest that CP is a minor risk factor for deep venous thrombosis in GIAC patients. To confirm this, however, the number of patients and controls should be larger. After 3 years of observation, the follow-up in 10 living GIAC patients showed nobody with thromboembolic disease.

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Section: Discussionmentioning

confidence: 73%

Cancer procoagulant in patients with adenocarcinomas

Kaźmierczak

Lewandowski

Wojtukiewicz

et al. 2005

Blood Coagulation &Amp; Fibrinolysis

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“…In those with idiopathic, i.e. unexplained VTE (IVTE) the reported prevalence of concomitant cancer at the time of VTE varies from 4 to 24% [3,[5][6][7][8][9][10][11][12][13]. The difference in these figures can, to a large extent, be explained by the extensiveness of the investigations performed at presentation.…”

Section: Introductionmentioning

confidence: 73%

“…Recent studies could not detect a survival benefit in patients with IVTE who underwent extensive screening involving, for example, testing of tumor markers, abdominopelvic ultrasound and computer tomography [3,6,9,13]. However, most of these studies were retrospective and/or included too few patients to be able to detect a significant difference.…”

Section: Discussionmentioning

confidence: 98%

Screening for Cancer in Patients with Idiopathic Venous Thromboembolism: The Clinical Practice

Otten

Smorenburg²,

Meij³

et al. 2002

Pathophysiol Haemos Thromb

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The reported incidence of concomitant cancer in patients with idiopathic venous thromboembolism (IVTE) varies between 4 and 24%, while the mean incidence of cancer within 3 years thereafter approximates 9%. Baseline investigations of patients with IVTE have been recommended. We evaluated the clinical practice regarding the screening of these patients according to these recommendations in two teaching hospitals. Medical history and physical examination were done reasonably exhaustively, except for investigations of the urogenital tract. Laboratory and imaging investigations were performed incompletely in a substantial proportion of the patients. The clinical evaluation regarding cancer, performed in patients with IVTE, could be improved. The implementation of a protocol should be considered.

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“…Venous thrombosis is a known association with malignancy 1. Thromboprophylaxis is given to high-risk patients with malignancy, and is continued into the perioperative period 2.…”

Section: Introductionmentioning

confidence: 99%

“…Thromboprophylaxis is given to high-risk patients with malignancy, and is continued into the perioperative period 2. Occasionally, patients present in the emergency department with features suggestive of venous thrombosis and are then diagnosed to have a malignancy as well 1. The management of patients with pre-existing deep venous thrombosis (DVT) and subsequently detected malignancy planned for urgent surgical procedures are not very well described in the literature.…”

Section: Introductionmentioning

confidence: 99%

Report on a patient with pre-existing venous thrombosis and incidental malignancy undergoing urgent laparotomy: preoperative concerns

Verma

Garg²

2009

Case Reports

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The management of a patient with pre-existing deep venous thrombosis (DVT) who was subsequently found to have a malignancy planned for urgent laparotomy is reported.A 30-year-old woman presented to the emergency room and was diagnosed to have a DVT. During work-up, she was found to have a malignanacy and was scheduled for urgent laparotomy. The patient was put on enoxaprin (injection) and warfarin (tablets). The patient was started on heparin (injection) 1000 IU/h at 72 h prior to operation, stopped 6 h prior to surgery. Anaesthesia and surgery were uneventful.A number of issues related to pre-existing DVTs prior to gynaecological surgery require further clarification; the optimal duration of pharmacological treatment, and the optimal duration/modality of prophylaxis to prevent thromboembolism in high-risk patients with cancer.Patients presenting for DVT must be evaluated for its causative factor(s), and malignancy in particular, based on clinical findings and investigations. Before planning surgical procedures, adequate anticoagulation must be achieved to prevent further complications of DVT, thromboembolism and pulmonary embolism in particular.

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“Idiopathic” Deep Venous Thrombosis: The Value of Routine Abdominal and Pelvic Computed Tomographic Scanning

Cited by 23 publications

References 14 publications

Cancer procoagulant in patients with adenocarcinomas

Cancer procoagulant in patients with adenocarcinomas

Screening for Cancer in Patients with Idiopathic Venous Thromboembolism: The Clinical Practice

Report on a patient with pre-existing venous thrombosis and incidental malignancy undergoing urgent laparotomy: preoperative concerns

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