Levi Marcel
Department of Medicine and Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Thromb Res. 2014 May;133 Suppl 2:S70-5. doi: 10.1016/S0049-3848(14)50012-6.
The association between cancer and thrombosis is known for years. Besides the well-recognized connection between venous thromboembolism and malignancies, there are, however, also other manifestations of cancer-related activation of coagulation and (micro)vascular dysfunction. In fact, coagulation derangements and vascular disturbances in patients with cancer cover a wide spectrum of diseases and various clinical manifestations. In this review we will highlight the mechanisms that play a role in the systemic activation of coagulation in cancer patients, in its most severe form manifested as disseminated intravascular coagulation. Clinically, disseminated intravascular coagulation (DIC) in cancer has in general a less fulminant presentation than the types of DIC complicating sepsis and trauma. A more gradual, but also more chronic, systemic activation of coagulation can proceed subclinically. The relationship between venous thromboembolism and cancer as a consequence of the hypercoagulability will be discussed as well. Furthermore, the role of perturbed endothelium in the pathogenesis of microvascular dysfunction and microangiopathy in particular in the setting of cancer and chemo- or radiotherapy will be reviewed.
癌症与血栓形成之间的关联已为人所知多年。除了静脉血栓栓塞与恶性肿瘤之间广为人知的联系外，癌症相关的凝血激活和（微）血管功能障碍还有其他表现形式。事实上，癌症患者的凝血紊乱和血管紊乱涵盖了广泛的疾病和各种临床表现。在本综述中，我们将重点介绍在癌症患者凝血系统激活中起作用的机制，其最严重的形式表现为弥散性血管内凝血。临床上，癌症患者的弥散性血管内凝血（DIC）通常不像并发脓毒症和创伤的DIC类型那样呈暴发性表现。凝血系统更渐进但也更慢性的全身性激活可能在亚临床状态下发生。高凝状态导致的静脉血栓栓塞与癌症之间的关系也将进行讨论。此外，还将综述内皮功能紊乱在微血管功能障碍和微血管病发病机制中的作用，特别是在癌症以及化疗或放疗背景下的作用。
