Marinho Felipe Costa de Andrade, Takagaki Teresa Yae
Department of Pulmonology of University of São Paulo School of Medicine, São Paulo, Brasil.
J Bras Pneumol. 2008 May;34(5):312-22. doi: 10.1590/s1806-37132008000500011.
The relationship between cancer and coagulopathy was suggested by Trousseau nearly 150 years ago. Later, it became more evident that oncologic patients are at a higher risk of experiencing thromboembolic events. This can be due to activation of the coagulation system either by neoplastic cells or by prescribed therapies (chemotherapy or surgical procedures). In fact, these events can constitute the first manifestation of cancer, and their recurrence, despite efficient anticoagulation, has been described. The coagulation system is normally activated in order to provide healing. In the presence of neoplasms, this complex system is activated as a response to multiple stimuli and seems to contribute to cancer progression. Activation of the coagulation system has a greater effect on metastatic foci than on the primary tumor. However, most cancer victims die from complications caused by metastasis, which underscores the importance of this theme. In this area, various mechanisms have been described, creating promising perspectives for future treatments. The current success in using low-molecular-weight heparins against small cell lung cancer is encouraging. Although the knowledge of those mechanisms is relatively incipient, many basic research and clinical studies are underway.
近150年前，特鲁索就提出了癌症与凝血病之间的关系。后来，越来越明显的是，肿瘤患者发生血栓栓塞事件的风险更高。这可能是由于肿瘤细胞或规定的治疗方法（化疗或外科手术）激活了凝血系统。事实上，这些事件可能是癌症的首发表现，而且尽管进行了有效的抗凝治疗，它们仍会复发。凝血系统通常被激活以促进愈合。在肿瘤存在的情况下，这个复杂的系统会作为对多种刺激的反应而被激活，并且似乎有助于癌症进展。凝血系统的激活对转移灶的影响比对原发肿瘤的影响更大。然而，大多数癌症患者死于转移引起的并发症，这突出了这个主题的重要性。在这个领域，已经描述了各种机制，为未来的治疗创造了有希望的前景。目前使用低分子量肝素治疗小细胞肺癌取得的成功令人鼓舞。尽管对这些机制的了解还相对初步，但许多基础研究和临床研究正在进行中。
