Naschitz Jochanan E
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Comprehensive Geriatric Ward, Bait Balev Nesher, Nesher, Israel.
Int J Angiol. 2021 Jul 19;30(4):249-256. doi: 10.1055/s-0041-1729920. eCollection 2021 Dec.
The association between venous thrombosis and malignancy, having typical features of a paraneoplastic syndrome, has been established for a century. Currently, it is recognized that arterial thromboembolism (ATE) may also behave as a paraneoplastic syndrome. Recent matched cohort studies, systematic reviews, and observational studies concur in showing an increased incidence of acute coronary events, ischemic stroke, accelerated peripheral arterial disease, and in-stent thrombosis during the 6-month period before cancer diagnosis, peaking for 30 days immediately before cancer diagnosis. Cancer patients with ATE are at higher risk of in-hospital and long-term mortality as compared with noncancer patients. In the present review, we focus on the epidemiology, clinical variants and presentation, morbidity, mortality, primary and secondary prevention, and treatment of cancer-associated ATE. The awareness that cancer can be a risk factor for ATE and that cancer therapy can initiate cardiovascular complications make it mandatory to identify high-risk patients, modify preexistent cardiovascular risk factors, and adopt effective antithrombotic prophylaxis. For ATE prophylaxis, modifiable patient-related risk factors and oncology treatment-related factors are levers for intervention. Statins and platelet antiaggregants have been studied, but their efficacy for prevention of cancer-associated ATE remains to be demonstrated. Results of revascularization procedures for cancer-associated ATE are worse than for ATE in noncancer patients. It is important that a multidisciplinary approach is adopted for making informed decisions, by involving the vascular surgeon, interventional radiologist, oncologist, and palliative medicine, as well as the patients and their family.
静脉血栓形成与恶性肿瘤之间的关联已被确立一个世纪，具有副肿瘤综合征的典型特征。目前，人们认识到动脉血栓栓塞（ATE）也可能表现为一种副肿瘤综合征。最近的配对队列研究、系统评价和观察性研究一致表明，在癌症诊断前6个月内，急性冠脉事件、缺血性卒中、加速性外周动脉疾病和支架内血栓形成的发生率增加，在癌症诊断前30天达到峰值。与非癌症患者相比，患有ATE的癌症患者住院和长期死亡风险更高。在本综述中，我们重点关注癌症相关ATE的流行病学、临床变异与表现、发病率、死亡率、一级和二级预防以及治疗。认识到癌症可能是ATE的一个危险因素，并且癌症治疗可能引发心血管并发症，这使得识别高危患者、改变已有的心血管危险因素以及采取有效的抗血栓预防措施成为必要。对于ATE预防，可改变的患者相关危险因素和肿瘤治疗相关因素是干预的杠杆。他汀类药物和血小板抗聚集剂已被研究，但其预防癌症相关ATE的疗效仍有待证实。癌症相关ATE的血管重建手术结果比非癌症患者的ATE更差。通过让血管外科医生、介入放射科医生、肿瘤学家、姑息医学专家以及患者及其家属参与，采用多学科方法做出明智决策非常重要。
