Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy; Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.
Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy; Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.
J Thromb Haemost. 2023 Jun;21(6):1397-1408. doi: 10.1016/j.jtha.2023.02.029. Epub 2023 Mar 15.
Thrombosis, both venous and arterial, is a leading cause of morbidity and mortality in patients with cancer. Studies on the molecular basis of cancer-associated thrombophilia have a long story starting from the first observation of the presence of tumor cells in circulating microthrombi 2 centuries ago. The profound link between pathways of blood coagulation and tumor biology has been more and more unraveled, and new actors in this complex interaction have been identified. The unfavorable impact of thrombosis in a patient with cancer, on which also hangs a high bleeding risk as compared to the noncancer population, has led during years to the production of large clinical studies to adopt the best prophylaxis and treatment strategies of venous thromboembolism in different medical and surgical settings, now incorporated in dedicated international guidelines. This field, however, still represents an open challenge due to the intrinsic variability of the patient with cancer with his/her personal medical history and cardiovascular risk factors, as well as the type, site and stage of the tumor, and the use of a wide array of new sophisticated anticancer drugs. This review aims to highlight some of the many key observations in the field of cancer and thrombosis, spanning the scope from fundamental tumor biology to advanced clinical trials of new anticoagulants. We hope that some of the examples we have included will inspire readers to explore and discuss these topics, thereby increasing awareness of cancer-related thrombosis in both physicians and patients.
血栓形成，无论是静脉血栓形成还是动脉血栓形成，都是癌症患者发病率和死亡率的主要原因。从 200 年前首次观察到肿瘤细胞存在于循环微血栓中开始，关于癌症相关血栓形成的分子基础的研究就有了很长的历史。凝血途径与肿瘤生物学之间的深刻联系越来越被揭示，这种复杂相互作用的新参与者也被确定。与非癌症人群相比，癌症患者的血栓形成对其具有不利影响，而且出血风险也很高，这导致多年来产生了大量的临床研究，以在不同的医疗和外科环境中采用预防和治疗静脉血栓栓塞症的最佳策略，现在这些策略已被纳入专门的国际指南。然而，由于癌症患者的固有个体差异，包括其个人病史和心血管危险因素、肿瘤的类型、部位和分期以及广泛使用新型复杂抗癌药物，这一领域仍然是一个悬而未决的挑战。这篇综述旨在强调癌症和血栓形成领域的一些重要观察结果，涵盖了从基础肿瘤生物学到新型抗凝剂的临床试验的范围。我们希望我们所包含的一些例子能激发读者对这些主题进行探索和讨论，从而提高医生和患者对癌症相关血栓形成的认识。
