Caine Graham J, Stonelake Paul S, Rea Daniel, Lip Gregory Y H
University Department of Medicine, City Hospital, Birmingham, United Kingdom.
Cancer. 2003 Oct 15;98(8):1578-86. doi: 10.1002/cncr.11702.
Patients with cancer are highly susceptible to thromboembolic complications, which account for a significant percentage of the morbidity and mortality of the disease. Up to 15% of patients with clinically overt cancer present with venous thromboembolism during the course of their disease. Moreover, patients with cancer represent 20% of all patients in whom deep venous thrombosis and pulmonary embolism are diagnosed. This prothrombotic state in cancer can occur due to the ability of tumor cells to directly activate the blood-clotting cascade and cause thrombosis or induce procoagulant properties and inhibit anticoagulant properties of vascular endothelial cells, platelets, monocytes, and macrophages. It also is well established that this prothrombotic tendency in patients with cancer can be enhanced greatly by anticancer treatments, such as surgery and chemotherapy. This phenomenon can be seen in patients with breast cancer, particularly after surgery and chemotherapy. Increased clotting risk also is associated with the use of central venous access devices, commonly used to administer chemotherapeutic agents in patients with cancer. Thrombosis prophylaxis, therefore, should be considered for patients with breast cancer who are at risk before and during intervention. In the current review, the authors discuss the problem of thromboembolism in patients with breast cancer who are undergoing therapy, the mechanisms by which thromboembolisms occur, and the potential strategies by which these events may be prevented. Better understanding of these pathogenetic pathways may lead to the development of more targeted strategies to prevent thromboembolism in patients with cancer.
癌症患者极易发生血栓栓塞并发症，此类并发症在该疾病的发病率和死亡率中占相当大的比例。高达15%的临床显性癌症患者在病程中会出现静脉血栓栓塞。此外，在所有被诊断为深静脉血栓形成和肺栓塞的患者中，癌症患者占20%。癌症中的这种血栓前状态可能是由于肿瘤细胞直接激活凝血级联反应并导致血栓形成的能力，或诱导血管内皮细胞、血小板、单核细胞和巨噬细胞的促凝特性并抑制其抗凝特性所致。同样公认的是，癌症患者的这种血栓前倾向可因手术和化疗等抗癌治疗而大大增强。这种现象在乳腺癌患者中可见，尤其是在手术和化疗后。凝血风险增加还与中心静脉通路装置的使用有关，该装置常用于给癌症患者输注化疗药物。因此，对于有风险的乳腺癌患者，在干预前和干预期间都应考虑进行血栓预防。在当前的综述中，作者讨论了正在接受治疗的乳腺癌患者的血栓栓塞问题、血栓栓塞发生的机制以及预防这些事件的潜在策略。对这些致病途径的更好理解可能会导致开发出更具针对性的策略来预防癌症患者的血栓栓塞。
