Venous thromboembolism and cancer: a systematic review.
Venous thromboembolism (VTE) is a serious and potentially fatal disorder, which is often associated with a significant impact on the quality of life and on the clinical outcome of cancer patients. The pathophysiology of the association between thrombosis and cancer is complex: malignancy is associated with a baseline hypercoagulable state due to many factors including release of inflammatory cytokines, activation of the clotting system, expression of hemostatic proteins on tumor cells, inhibition of natural anticoagulants, and impaired fibrinolysis. Several risk factors, related to the patient, the disease, and the therapeutic interventions, have been identified as contributing to the occurrence of VTE. There is convincing evidence to recommend the use of heparins or fondaparinux for prevention of VTE in selected cancer patients, and, especially in some particular types of malignancies and cancer treatments. Management of VTE in patients with cancer is more challenging and bleeding complications associated with the use of anticoagulants are significantly higher in cancer patients than in those without malignancy. Important issues that need to be considered in all cases are interference with anticancer therapy, inconvenience of treatment, and impact on quality of life.
Centro de Oncologia, Hospital Sirio Libanês, São Paulo, SP, Brazil. celsoarrais@uol.com.br
Celso Arrais
CA
Rodrigues
Renata
R
Ferrarotto
Roberto
R
Kalil Filho
Yana A S
YA
Novis
Paulo M G
PM
Hoff
D000077425:Fondaparinux; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011134:Polysaccharides / Q000627:therapeutic use; D011788:Quality of Life; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux