Cancer related thromboses- Oncological emergencies
Oncological emergencies - Cancer related thrombosis
Cancer related thrombosis is first documented by Trousseau who unfortunately died from thrombosis as a complication of cancer. There are 2 reasons for the development of the cancer related thrombosis. The first reason is associated with the tumor mass or nodal mass that impinge upon the vasculature which leads to venous stasis and finally thrombosis. The second reason is the release of the pro -coagulants from the tumor such as factor S and factor C as well as factor 10 which activates the coagulations or clotting cascades.
The incidence of thromboembolism and venous thrombosis are variable in cancer patients Based on one study, that is focus on screening of the patient with deep venous thrombosis , around 30% of them had cancer which is commonly pelvic malignancy. Recent study indicates that 5% of patient suffer from deep venous thrombosis suffer from undetected cancer. Once cancer has been diagnosed in about 10% of all cancer patient may suffer from thromboembolic event. The incidence of venous thrombosis will increase significantly when long lines for the purpose of supportive care and chemotherapy are inserted in cancer patients. This will increase the incidence of thromboembolism event to 20%.
For this reason, it is recommended to prescribe low dose warfarin as prophylaxis. This will reduce the risk for subsequent thrombosis between 2% to 5%. Anticoagulation should be prophylatically prescribed because of the high risk of thrombosis in cancer patients. Heparin like compound rather than coumarin is the best way in preventing thromboembolism .Besides that, there are studies which indicates low molecular weight heparin is more beneficial as prophylaxis compare to warfarin.
There is also a modest advantage of survival for patients with the usage of low molecular weight heparin. In the case where the patient suffer from recurrent thromboses and pelvic tumor it is advisable that the patient is inserted with filter to prevent and reduce the risk of pulmonary embolism. The benefits of filters are transients.
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