Disorders of hemostatic system in patients with malignant disease, especially in view of venous thromboembolism

Orvosi Hetilap. 2007 Sep 9;148(36):1691-7. [Link]

Bozóky G, Ruby E, Góhér I, Mohos A, Bálint C, Bozóky I.

Bács-Kiskun Megyei Onkormányzat Kórháza Tüdobelgyógyászati Osztály Kecskemét, Pf. 149., 6000. bozokyg@freemail.hu


Introduction: An increased suspectibility to thrombosis demonstrated in laboratory analysis of solid malignant diseases develops as a result of the activating effect of malignant cells on the hemostatic system. The development of this activating effect is a consequence of interactions between malignant cells and the various components of the coagulation system (coagulation factors, platelets, endothelial cells, fibrinolytic system) which leads from a prothrombotic state to clinically identifiable disorders of the hemostatic system.

Aims: In a retrospective analysis, authors sought to answer what characteristics and frequency of hemostatic disorders developed in a great number of cases with malignant diseases.

Method: Between 1996 and 2004, solid malignant diseases were diagnosed in 1381 patients by histological and/or cytological examinations. Most of the patients suffered from primary bronchopulmonary carcinoma ( n = 1140). In the rest of the cases, malignant processes were located in breast, colorectal system, kidney, bladder, thyroid gland and pancreas. Mesothelioma was diagnosed in six patients by histological analysis. Based on the examinations of clinical stage-definition, the malignant disease was in an advanced stage. The authors examined the characteristics and frequency of hemostatic disorders showed with special regard to the incidents of venous thromboembolism in patients with cancer. The role of existing non-malignant associative diseases concerning the development of hemostatic disorders was also given a special attention.

Result: Out of the 1381 patients with malignant disease, clinically identifiable hemostatic disorders were found in 397 cases (28.7%). Venous thrombosis and acute pulmonary embolism happened to be the most frequent ones ( n = 305, 22%). Migrating superficial thrombophlebitis, septic thrombosis, acute diffuse intravascular coagulation, and microangiopathic hemolytic anemia developed in 71 patients (6.7%).

Conclusion: Active cancer is often associated with hypercoagulable state, which pertubs the hemostatic balance between anticoagulant and procoagulant forces, creating a prothrombotic state. The interaction between tumor cells and host cells involves direct cell-cell interaction or indirect mechanism by cytokine release. Hypercoagulable state in patients with malignant disease may result in the occurence of various clinically identifiable hemostatic system disorders: the most frequent one is venous thromboembolism (so-called secondary thrombosis). In cases of idiopathic venous thromboembolism, it is recommended to carry out specific clinical check-up to prove or to preclude asymptomatic malignant diseases.

Keywords: malignant disease, hypercoagulable state, increased suspectibility to thrombosis, hemostatic disorders