THROMBOEMBOLIC COMPLICATIONS ASSOCIATED WITH BRAIN-TUMORS

Thromboembolic complications are the second most common cause of death in hospitalized cancer patients; they are caused by alterations of he mostasis and include hypercoagulable states, acute and chronic dissemi nated intravascular coagulation, and primary fibrinolysis. The fibrino lytic system is comprised of several serine protease enzymes and their inhibitors and is associated in various biological systems with physi ological and pathological events such as tissue development, remodelin g, invasiveness, and migratory potentials of both normal and malignant cells. It also plays a key role in the dissolution of fibrin strands. Defective fibrinolysis, which is often associated with the pathogenes is of venous thrombosis and other thromboembolic complications, occurs when the balance is disrupted, resulting in either inhibition or enha ncement of fibrinolysis. The association between thromboembolic compli cations and neoplastic disease has been well-established since Trousse au in 1865 first reported a high incidence of venous thrombosis in a s eries of patients with gastric carcinoma. In this article, we discuss the factors that have been shown to be associated with thromboembolic complications in patients who harbor brain tumors, namely, hemostatic alterations caused by the tumors themselves or through interactions wi th neural tissue around the tumors, pre-operative hemostatic alteratio ns in certain patients, and defective fibrinolysis associated with spe cific tumor types and/or tumor locations.