Mousa S A
Albany College of Pharmacy, 106 New Scotland Avenue Albany, NY 12208-3492, USA.
Hamostaseologie. 2005 Nov;25(4):380-6.
Many cancer patients have a hypercoagulable state, with recurrent thrombosis due to the impact of cancer cells and chemotherapy or radiotherapy on the coagulation cascade. Studies have demonstrated that unfractionated heparin (UFH) or its low molecular weight fractions interfere with various processes involved in tumour growth and metastasis. These include fibrin formation; binding of heparin to angiogenic growth factors, such as basic fibroblast growth factor (FGF2) and vascular endothelial growth factor (VEGF); modulation of tissue factor; and perhaps other more important modulatory mechanisms, such as enhanced tissue factor pathway inhibitor (TFPI) release and inhibition of various matrix-degrading enzymes. Clinical trials have suggested a clinically relevant effect of low molecular weight heparin (LMWH), as compared to UFH, on the survival of cancer patients with deep vein thrombosis. Similarly, the impact of warfarin on the survival of cancer patients with thromboembolic disorders was demonstrated. Studies from our laboratory demonstrated a significant role for LMWH, warfarin, anti-VIIa, and LMWH-releasable TFPI on the regulation of angiogenesis, tumour growth, and tumour metastasis. Thus, modulation of tissue factor/VIIa non-coagulant activities by LMWH, warfarin, anti-VIIa, or TFPI might be a useful therapeutic method for the inhibition of angiogenesis associated with human tumour growth and metastasis. Additionally, antiplatelet drugs could have an impact on tumour metastasis, and the combination of antiplatelets and anticoagulants at adjusted doses might provide greater benefits to cancer patients.
许多癌症患者处于高凝状态,由于癌细胞以及化疗或放疗对凝血级联反应的影响而反复发生血栓形成。研究表明,普通肝素(UFH)或其低分子量片段会干扰肿瘤生长和转移涉及的各种过程。这些过程包括纤维蛋白形成;肝素与血管生成生长因子如碱性成纤维细胞生长因子(FGF2)和血管内皮生长因子(VEGF)的结合;组织因子的调节;以及可能其他更重要的调节机制,如增强组织因子途径抑制剂(TFPI)释放和抑制各种基质降解酶。临床试验表明,与普通肝素相比,低分子量肝素(LMWH)对患有深静脉血栓形成的癌症患者的生存具有临床相关影响。同样,华法林对患有血栓栓塞性疾病的癌症患者生存的影响也得到了证实。我们实验室的研究表明,低分子量肝素、华法林、抗VIIa以及可从低分子量肝素释放的TFPI在血管生成、肿瘤生长和肿瘤转移的调节中发挥重要作用。因此,通过低分子量肝素、华法林、抗VIIa或TFPI调节组织因子/VIIa的非凝血活性可能是抑制与人类肿瘤生长和转移相关的血管生成的一种有用治疗方法。此外,抗血小板药物可能会对肿瘤转移产生影响,调整剂量的抗血小板药物和抗凝剂联合使用可能会给癌症患者带来更大益处。