title: Haemostatic challenges in the cancer patient: focus on the perioperative period.
abstract: Cancer patients are at high risk of thrombo-embolism and haemorrhage - which is exacerbated in the perioperative period. The pathogenesis of this haemostatic dysfunction is complex and involves the interplay of multiple factors. A detailed understanding of the disease pathophysiology, including mechanisms of haemostasis and laboratory assessment, is imperative in the decision making. Thrombo-embolism is an important and preventable complication of cancer surgery - with appropriate application of thromboprophylaxis. The key outstanding issues surround timing of initiation, regimen and duration of therapy. A major limitation in both our understanding and our pre-emptive management of the haemostatic dysfunction is a lack of sensitive and specific tests of haemostatic potential that can provide predictive power for risk stratification. Routine laboratory tests do not accurately recognise hyper- or hypocoagulable states, or test the clinical effects of procoagulant or anticoagulant interventions. We need further development of cellular-based assays that incorporate all the components of the haemostatic system.
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Electronic address: kate.burbury@petermac.org.
authors.forename: Kate
authors.initials: K
authors.lastname: Burbury
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D003657:Decision Making; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006487:Hemostasis; D006801:Humans; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D059035:Perioperative Period / Q000379:methods*; D012306:Risk; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000925:Anticoagulants
keywords: cancer; haemorrhage; hypercoagulability; perioperative; thrombo-embolism