Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2021 Jun 4;100(22):e26152. doi: 10.1097/MD.0000000000026152.
Patients with cancer have elevated risk of both venous thromboembolism and bleeding compared with patients without cancer due to cancer- and patient-specific factors. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult because management of cancer-associated thrombosis requires anticoagulation despite its known increased risks for bleeding. The adjustment of blood transfusion or cessation of anticoagulants can be a challenge in surgical diagnosis or treatment of cancer patients with such an imbalanced coagulate status.
A 45-year-old woman with no underlying disease was suspected of ovarian cancer and was awaiting diagnostic laparoscopic exploration surgery.
While waiting for the surgery, the patient developed chest pain and underwent stent insertion under diagnosis of myocardial infarction. Two weeks later, endocarditis developed, and replacement of the aortic valve and mitral valve was planned. In addition, the patient developed multiple thromboembolisms and was administered anticoagulants to eliminate vegetation of valves and multiple thromboses. Her blood test showed anemia (7.4 g/dL) and severe thrombocytopenia (24 × 109/L).
The patient underwent double valve replacement.
A color change of the left lower extremity was noted 5 hours after double valve replacement, and angiography was performed. Thrombectomy was performed under diagnosis of thrombosis in the left iliac artery. One month later, the patient underwent laparoscopic exploration surgery as scheduled.
This case will help establish the criteria of blood coagulation for surgical treatment of cancer patients with imbalanced clotting and bleeding.
与无癌症患者相比，癌症患者由于癌症和患者自身因素，存在静脉血栓栓塞和出血的风险增加。由于癌症相关血栓形成的管理需要抗凝，尽管其已知出血风险增加，但平衡这些患者的凝血和出血的风险增加和相互竞争的风险可能具有挑战性。在有这种凝血失衡状态的癌症患者的手术诊断或治疗中，调整输血或停止抗凝可能是一个挑战。
一位 45 岁的无潜在疾病的女性被怀疑患有卵巢癌，正在等待诊断性腹腔镜探查手术。在等待手术期间，患者出现胸痛，并在诊断为心肌梗死的情况下进行了支架置入。两周后，发生了心内膜炎，并计划更换主动脉瓣和二尖瓣。此外，患者发生了多次血栓栓塞，并接受了抗凝治疗以消除瓣膜的赘生物和多个血栓。她的血液检查显示贫血（7.4 g/dL）和严重血小板减少症（24×109/L）。
患者接受了双瓣置换术。
在双瓣置换术后 5 小时，注意到左下肢颜色改变，并进行了血管造影。在左髂动脉诊断为血栓形成的情况下进行了血栓切除术。一个月后，患者按计划接受了腹腔镜探查手术。
该病例将有助于为有凝血和出血失衡的癌症患者的手术治疗确立凝血标准。
