Cancer-related coagulopathy (Trousseau's syndrome): Review of the literature and experience of a single center of internal medicine

Franco Dammacco, Angelo Vacca, Pasquale Procaccio, Roberto Ria, Ilaria Marech, Vito Racanelli

Research output: Contribution to journalArticle

Abstract

Venous thromboembolism (VTE) occurs roughly in one out of five cancer patients and is the second cause of death in this population. When all cancer patients are considered together, a sevenfold increased risk for VTE has been calculated. Over the last 20 years, a number of risk factors have been recognized. These have been used in several risk assessment models aimed at identifying high-risk patients who are therefore candidates for thromboprophylaxis. An easily applicable and reliable risk score is based on the cancer site, hemoglobin levels, pre-chemotherapy platelet and leukocyte counts as well as body mass index. The additional measurement of two biomarkers, namely D-dimer and soluble P-selectin, may improve estimates of the cumulative VTE probability. A variable incidence of VTE has been determined in patients with specific types of malignancy, with the highest odds in those with pancreatic cancer followed by head and neck tumors. In terms of histotype, the risk of VTE is significantly higher in patients with adenocarcinoma than in those with squamous cell carcinoma and in patients with high-grade versus low-grade tumors. Cancer therapy may also be responsible for VTE; specifically, the presence of an indwelling central venous catheter, immunomodulatory drugs such as thalidomide and lenalidomide, monoclonal antibodies, such as bevacizumab, erythropoiesis-stimulating agents and hormonal therapy with tamoxifen place patients at higher risk. The pathogenesis of cancer-related VTE is poorly understood but is likely to be multifactorial. "Virchow's triad," comprising stasis consequent to a decreased blood flow rate, an enhanced blood clotting tendency such as accompanies inflammation and growth factor expression, and structural modifications in blood vessel walls, is thought to play a central role in the induction of VTE. The prophylaxis and treatment of VTE are based on well-established drugs such as vitamin K antagonists and unfractionated and low-molecular-weight heparins as well as on an expanding group of new oral anticoagulants, including fondaparinux, rivaroxaban, apixaban and dabigatran. Furthermore, aspirin has been shown to prevent arterial thrombosis and to reduce the rate of major vascular events. Guidelines for the general management of VTE in cancer patients and in those with an indwelling central venous catheter have been recently developed with the aim of selecting the most rational therapeutic approach for each clinical situation. The main features of VTE based on our own observations of 92 cancer patients and 159 patients with non-neoplastic disease are briefly described herein.

Original languageEnglish
Pages (from-to)85-97
Number of pages13
JournalClinical and Experimental Medicine
Volume13
Issue number2
DOIs
Publication statusPublished - May 2013

Fingerprint

Venous Thromboembolism
Internal Medicine
Neoplasms
Catheters
Tumors
Blood
Hematinics
Indwelling Catheters
Central Venous Catheters
Thalidomide
P-Selectin
Chemotherapy
Vitamin K
Low Molecular Weight Heparin
Blood vessels
Biomarkers
Tamoxifen
Platelets
Blood Vessels
Pharmaceutical Preparations

Keywords

  • Cancer-related coagulopathy
  • Deep-vein thrombosis
  • Low-molecular-weight heparins
  • Pulmonary embolism
  • Trousseau's syndrome
  • Venous thromboembolism

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Cancer-related coagulopathy (Trousseau's syndrome) : Review of the literature and experience of a single center of internal medicine. / Dammacco, Franco; Vacca, Angelo; Procaccio, Pasquale; Ria, Roberto; Marech, Ilaria; Racanelli, Vito.

In: Clinical and Experimental Medicine, Vol. 13, No. 2, 05.2013, p. 85-97.

Research output: Contribution to journalArticle

Dammacco, Franco ; Vacca, Angelo ; Procaccio, Pasquale ; Ria, Roberto ; Marech, Ilaria ; Racanelli, Vito. / Cancer-related coagulopathy (Trousseau's syndrome) : Review of the literature and experience of a single center of internal medicine. In: Clinical and Experimental Medicine. 2013 ; Vol. 13, No. 2. pp. 85-97.
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