title: Disseminated intravascular coagulation with excessive fibrinolysis in prostate cancer: a case series and review of the literature.
abstract: OBJECTIVE
  To describe the clinical characteristics, diagnostic features, prognosis, and outcome of patients with prostate cancer and disseminated intravascular coagulation with excessive fibrinolysis (DIC XFL).
  
  
  METHODS
  We performed a retrospective analysis of prostate cancer patients seen at a single center from March 21, 2000, to July 31, 2006, with a fibrinogen level <150 mg/dl and two of the following criteria: platelets <150 × 10(9)/l, D-dimer >0.5 μg/ml, prothrombin time and activated partial thromboplastin time exceeding normal values, hemorrhage and/or thrombosis. Patients with comorbid conditions that cause coagulopathy were excluded.
  
  
  RESULTS
  Forty-two patients met the inclusion criteria. Most patients had high-grade prostate cancer (26% had Gleason 7 and 45% had Gleason 8-10). Three patients developed DIC XFL following surgery and 39 patients in the setting of metastatic disease; 93% were resistant to castration, and 50% had received prior taxanes. No deep-vein thromboses were documented. Management included blood transfusion, heparin, hormones, and chemotherapy. Median survival was 4 weeks. DIC XFL reversal was seen in 20% of metastatic patients, all of whom received new chemotherapy regimens. Median survival in this group was 26 weeks.
  
  
  CONCLUSIONS
  DIC XFL is a rare complication of prostate cancer. Untreated, the risk of hemorrhage is high and the prognosis poor. Reversal of DIC XFL appears to correlate with response to new anticancer therapy.
authors: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors: David M
authors: DM
authors: Hyman
authors: Gerald A
authors: GA
authors: Soff
authors: Lewis J
authors: LJ
authors: Kampel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies