The thrombophilic state in cancer patients

Thrombosis and disseminated intravascular coagulation are common complicati ons of cancer. Specific conditions associated with cancer such as stasis du e to immobilization or blood flow obstruction, surgery, infections, endothe lium damage due to chemotherapeutic agents and abnormalities of blood coagu lation contribute to the hypercoagulable and thrombophilic state of cancer patients. This procoagulant state in cancer arises mostly from the capacity of tumor cells to express and release procoagulant activities (cancer proc oagulant and tissue factor). Decreased levels of inhibitors of coagulation, impaired fibrinolysis, the presence of anti phospholipid antibodies and an acquired activated protein C resistance contribute to the hypercoagulable state. The activation of coagulation is also implicated in tumor proliferat ion through interactions of coagulation with inflammation and increased tis sue factor pathway inhibitor. Laboratory diagnosis of the thrombophilic sta te include (1) elevation of clotting factors, fibrinogen/fibrin degradation products, hyperfibrinogenemia and thrombocytosis and (2) elevation of spec ific markers of activation of coagulation: fibrinopeptide A, fragment 1 + 2 , thrombin-antithrombin complexes and D-dimers. However, none of the tests has any predictive value for the occurrence of thrombotic events in one ind ividual patient. In patients with venous thromboembolism a noninvasive scre ening for occult cancer is able to detect a relatively high incidence of hi dden cancer and the search for thrombophilia, seems important in patients w ithout known cancer. Copyright (C) 2001 S. Karger AG, Basel.