University of Birmingham Centre for Cardiovascular Sciences, Department of Medicine, City Hospital, Birmingham B18 7QH, UK.
Cardiol Res Pract. 2011 Mar 3;2011:394740. doi: 10.4061/2011/394740.
The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.
最常见的最终死因是心肌骤停。在许多情况下，这是由于心肌缺氧引起的，通常是由于冠状动脉大循环和微循环无法向心肌细胞输送足够的充氧红细胞所致。造成这种情况的主要原因是闭塞性血栓形成，要么是孤立的循环血栓形成，要么是上游斑块破裂。然而，导致心脏潜在致命压力的另一种更严重的病理学是心脏外疾病，如肺动脉高压。后者的主要原因是肺栓塞，被认为是静脉血栓栓塞症。虽然血栓形成情况几十年来一直是心血管疾病的主导范式，但直到最近，癌症中很少考虑这些问题。然而，现在有一种观点认为癌症也是一种血栓性疾病，特别是一种主要发生在静脉循环的疾病，表现为深静脉血栓形成和肺栓塞。事实上，对许多人来说，静脉血栓栓塞症是癌症发展的第一个症状之一。此外，癌症的许多标准化疗药物具有促血栓形成作用。因此，癌症的肝素或口服抗凝剂（如华法林）的血栓预防，特别是在高危人群（如不能活动和接受高剂量化疗的人群）中，可能是一种重要的治疗方法。本通讯的目的是总结目前对癌症中动脉和静脉血栓形成的流行病学和病理生理学的看法。
