Gouin-Thibault I, Samama M M
Service d'Hématologie Biologique, Hôtel-Dieu, Paris, France.
Semin Thromb Hemost. 1999;25(2):167-72. doi: 10.1055/s-2007-994918.
Perturbations of coagulation in cancer patients have been described for a long time. In up to 90% of cancer patients "routine" blood tests are abnormal leading to a hypercoagulable state in these patients. Among these tests are an increase in clotting factors, fibrinogen, fibrinogen/fibrin degradation products, and thrombocytosis. Markers of the activation of coagulation have been developed, and levels of FPA, F1+2, TAT, and D-Dimer have been found higher in cancer patients. More specific procoagulant activities in cancer (CP and TF) have also been described and can be measured but none of them have any predictive value for the occurrence of venous thromboembolism in these patients. Consistent with this hypercoagulable state in cancer is the finding that most cancer patients have reduced plasma levels of inhibitors of coagulation. These complex abnormalities are clinically expressed as thrombosis, low-grade or fulminant DIC which can be assessed by different laboratory tests, and as hemorrhage when the fibrinolysis system is impaired. However, no studies have shown to date a relationship between these abnormalities of the coagulation tests and the clinical expression in any single individual. Because these patients are at high risk for thrombosis in special conditions such as surgery or during chemotherapy, prophylaxis with various forms of heparin are recommended.
癌症患者凝血功能紊乱已被描述很长时间了。高达90%的癌症患者“常规”血液检查异常，导致这些患者处于高凝状态。这些检查结果包括凝血因子、纤维蛋白原、纤维蛋白原/纤维蛋白降解产物增加以及血小板增多。凝血激活标志物已被研发出来，并且发现癌症患者的FPA、F1+2、TAT和D-二聚体水平更高。癌症中更具特异性的促凝活性（癌促凝蛋白和组织因子）也已被描述且可进行检测，但它们对这些患者静脉血栓栓塞的发生均无预测价值。与癌症患者的这种高凝状态相一致的是，大多数癌症患者血浆中凝血抑制剂水平降低。这些复杂的异常情况在临床上表现为血栓形成、可通过不同实验室检查评估的轻度或暴发性弥散性血管内凝血，以及当纤溶系统受损时出现的出血。然而，迄今为止尚无研究表明凝血检查的这些异常与任何个体的临床表现之间存在关联。由于这些患者在手术或化疗等特殊情况下发生血栓的风险很高，因此建议使用各种形式的肝素进行预防。
