Vitale Felice Vito, Longo-Sorbello Giuseppe Sa, Rotondo Stefano, Ferrau Francesco
Divisione di Oncologia Medica, Ospedale San Vincenzo, Messina, Italy.
Divisione di Ematologia, Ospedale San Vincenzo, Messina, Italy.
SAGE Open Med. 2017 Dec 21;5:2050312117749133. doi: 10.1177/2050312117749133. eCollection 2017.
A systemic activation of blood coagulation is usually present in many clinical conditions including the infectious or inflammatory ones and malignant disease as well. Depending upon circumstances, patients suffering from acute decompensated disseminated intravascular coagulation may be managed by a medical oncologist and either an internist or a physician working in an emergency and/or intensive care unit. In some cases, for example, the indolent ones, the activation of coagulation might not be easily detected by routine laboratory tests and not lead to clinical manifestations. Such a chronically activated intravascular coagulation can progress toward an overt decompensated disseminated intravascular coagulation. Traditional therapy of decompensated disseminated intravascular coagulation is based on reversing the underlying triggering disease and providing patients with adequate supportive treatment. The dilemma for the oncologist is whether or not the trigger cause can be treated and amended with a specific antineoplastic treatment, without worsening the consumption of platelets and the risk of bleeding. In light of the availability of new targeted therapies, the main criteria that should drive the strategy against solid cancer-related disseminated intravascular coagulation will be discussed.
在许多临床病症中，包括感染性或炎症性病症以及恶性疾病，通常都会出现血液凝固的全身性激活。根据具体情况，患有急性失代偿性弥散性血管内凝血的患者可能由肿瘤内科医生以及内科医生或在急诊科和/或重症监护病房工作的医生进行治疗。例如，在某些情况下，如病情发展缓慢的情况，凝血激活可能不易通过常规实验室检查检测到，也不会导致临床表现。这种慢性激活的血管内凝血可能会发展为明显的失代偿性弥散性血管内凝血。失代偿性弥散性血管内凝血的传统治疗方法是基于逆转潜在的引发疾病并为患者提供充分的支持性治疗。肿瘤学家面临的困境是，引发原因能否通过特定的抗肿瘤治疗进行治疗和改善，同时又不会加重血小板的消耗和出血风险。鉴于新的靶向治疗方法的出现，将讨论针对实体癌相关弥散性血管内凝血的治疗策略应遵循的主要标准。
