Thrombophilia and Cancer

Abstract

Inherited and acquired thrombophilia are well-known risk factors for venous thromboembolism. The incidence of thrombotic events in cancer patients is increased compared to normal population. Data on inherited thrombophilia and cancer is limited. Most studies are small, and results are varied by geography, tumor type, stage of disease and therapy. Nevertheless, it seems that factor V Leiden and prothrombin mutation may increase VTE risk in cancer patients. Data also exist for hyperhomocysteinemia. Cancer patients with thrombophilia who have a central vein catheter are a special group with increased venous thrombotic event (VTE) risk. Among acquired risk factors, antiphospholipid antibodies are common in cancer patients, especially in lymphoproliferative diseases. Published data suggests that the risk of thrombotic events, venous and arterial, is increased in cancer patients with antiphospholipid antibodies. The questions of screening cancer patients for inherited thrombophilia or antiphospholipid antibodies are unclear. There is no data on primary VTE prophylaxis in cancer patients with thrombophilia and prophylaxis for cancer patients with central vein catheters is controversial.

A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery—the APAP trial (ISRCTN45810007)

“…In the context of surgery, hypoxic states, the systemic inflammatory syndrome and the acute phase reaction to surgical trauma further promote platelet adhesiveness and plaque instability and decrease fibrinolysis [10,11]. In addition, certain pathologies, such as carcinoma or diabetes, are being discussed to be per se associated with hyper-coagulability and/or aspirin resistance [30][31][32][33][34], thus possibly further adding to the risk of acute cardiac events in the perioperative period. Such events account for one third of perioperative deaths [35] and are associated with longterm mortality rates [36] and prolonged hospital stay [37,38].…”

Stroke and Cancer

“…We propose that diagnostic workup should include a broad laboratory assessment of hypercoagulability including d-dimer levels in all patients with cancer+stroke. 31 In addition, patients with suspected cancer-associated hypercoagulability should also be screened for other thromboembolic complications such as deep vein thrombosis, which is of utmost therapeutic relevance.…”

Hypercoagulability and Hypofibrinolysis and Risk of Deep Vein Thrombosis and Splanchnic Vein Thrombosis

“…53 Cancer patients have an increased risk of venous thrombosis as a result of multiple factors, such as activation of coagulation by tumor cells, resulting in hypercoagulability; compression of veins by the tumor; hospitalization; surgery; and chemotherapy. 54,55 VTE can be diagnosed in 4% to 20% of patients with cancer and is one of the leading causes of death in these patients. 56 MPNs are also associated with an increased risk of thrombotic complications, including venous and arterial thrombosis and microcirculatory disorders, such as erythromelalgia.…”