Tuzovic Mirela, Herrmann Joerg, Iliescu Cezar, Marmagkiolis Kostas, Ziaeian Boback, Yang Eric H
UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA.
Division of Cardiovascular Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Curr Treat Options Cardiovasc Med. 2018 Apr 7;20(5):40. doi: 10.1007/s11936-018-0635-x.
Cancer is a common cause of morbidity and mortality in the USA. While the association between venous thrombosis and malignancy is well established, arterial thrombosis has more recently been recognized as a serious complication of cancer and certain chemotherapeutic agents. This review aims to summarize the most recent literature regarding the incidence and risk factors for cancer-related arterial thrombosis, understand the pathophysiologic mechanisms of thrombosis, and highlight the specific diagnostic and treatment considerations relevant to cancer patients.
Based on a recent study looking at the Surveillance, Epidemiology, and End Results (SEER) database, the incidence of arterial thromboembolic events (ATEs) in patients with cancer at 6 months is 4.7%; the presence of an ATE is predictive of worse outcomes. Certain drugs such as platinum-based agents, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, and taxanes have been associated with high rates of ATEs. Increased platelet reactivity appears crucial to development of arterial thrombosis in cancer patients. Cancer patients have an increased risk of arterial thrombosis that is likely due to both a cancer-associated procoagulant state as well as the adverse effects of certain chemotherapeutic agents. Treatment of arterial thromboembolism in cancer patients typically requires a multidisciplinary approach in part due to high rates of thrombocytopenia and stent thrombosis in the setting of percutaneous interventions. More studies are needed to investigate optimal prophylaxis, surveillance strategies, and treatments of cancer-related arterial thromboembolic disease.
癌症是美国发病和死亡的常见原因。虽然静脉血栓形成与恶性肿瘤之间的关联已得到充分证实，但动脉血栓形成最近才被确认为癌症和某些化疗药物的严重并发症。本综述旨在总结有关癌症相关动脉血栓形成的发病率和危险因素的最新文献，了解血栓形成的病理生理机制，并强调与癌症患者相关的具体诊断和治疗注意事项。
基于最近一项对监测、流行病学和最终结果（SEER）数据库的研究，癌症患者在6个月时发生动脉血栓栓塞事件（ATE）的发生率为4.7%；ATE的存在预示着更差的预后。某些药物，如铂类药物、血管内皮生长因子抑制剂、酪氨酸激酶抑制剂和紫杉烷类药物，与ATE的高发生率相关。血小板反应性增加似乎对癌症患者动脉血栓形成的发展至关重要。癌症患者发生动脉血栓形成的风险增加，这可能是由于癌症相关的促凝状态以及某些化疗药物的不良反应所致。癌症患者动脉血栓栓塞的治疗通常需要多学科方法，部分原因是在经皮介入治疗中血小板减少和支架血栓形成的发生率较高。需要更多的研究来调查癌症相关动脉血栓栓塞疾病的最佳预防、监测策略和治疗方法。
