Therefore, prevention and treatment of this complications are contributing to increasing the survival and quality of life in cancer patients.
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Prevention can be achieved by identifying daca ai avut prostatita at high risk of developing thromboembolic complications and prophylaxis and treatment of recurrence must be properly chosen. Treatment with low molecular weight heparin in cancer patients is a safe treatment option and do not increase prostatita poate provoca avort spontan? risk of major bleeding.
In correctly selected cases, oral anticoagulants have indication of replacement therapy with low molecular weight heparins. Prin urmare, prevenirea şi tratamentul acestei complicaţii contribuie la creşterea supravieţuirii şi calitatea vieţii la pacienţii cu cancer. Prevenirea poate fi realizată prin identificarea pacienţilor cu risc crescut de apariţie a complicaţiilor tromboembolice şi profilaxia şi tratamentul recurenţei trebuie să fie ales în mod corespunzător.
Tratamentul cu heparină de greutate moleculară mică la pacienţii cu cancer este o opţiune sigură de tratament şi nu creşte riscul de sângerare majoră.
În cazurile selectate corect, anticoagulantele orale sunt indicate în terapia de substituţie cu heparine cu greutate moleculară mică. Moreover, cancer is a major risk factor for venous thromboembolism, with an increased incidence of times 2,3.
The close association between cancer and venous thromboembolism is well known, it was first reported in by Trousseau 4. The occurrence of venous thromboembolism in patients with cancer is caused by a hypercoagulable state by activation of coagulation by tumor cells, due to the synthesis of pro-coagulant factors, cytokines TNF, IL-1b, VEGF or by stimulating direct intercellular interaction with endothelial cells, leucocytes or platelets.
Tumor cells constitutively express tissue factor, the main activator of coagulation, which initiates angiogenesis and vascular endothelial penetration by tumor cells 3,6. Another pro-coagulant factor produced by tumor cells is a cysteine proteinase that activates Factor X in a Factor VIIa independent manner.
TNF and IL-1b stimulate endothelial expression of tissue factor and inhibit expression cancer prostate stage 4 life expectancy thrombomodulin. VEGF stimulates angiogenesis and inhibits apoptosis. Also, tumor cells express cell surface adhesion molecules which fosters direct interaction with endothelial cells, platelets, white blood cells, fibronectin and von Willebrand factor 3,7,8. The emergence of venous thromboembolism phenomena in patients with cancer severely affects disease prognosis, especially if this complication is experienced early within the first month after diagnosishighlighting an aggressive evolution of the disease or metastatic disease.
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Also, these patients have an increased risk of relapse of embolic phenomena, especially in the first months after diagnosis, and keep up even a few years 9. During chemotherapy, cancer patients show a 7 times higher risk of developing thromboembolism than patients without cancer 9. Background Clinicians cancer prostate stage 4 life expectancy underestimate the prevalence of embolic phenomena and their negative impact on patients. All patients known with venous thrombosis developed during neoplastic disease, who present at admission in the Departments of Oncology and Palliative Care in Romania, were in treatment with oral anticoagulants coumarins acenocumarolrequiring frequent therapeutic dose adjustment.
Most commonly, due to reduced accessibility of the patient to health care, especially in rural areas, the possibility of weekly assessment and precise adjustment of the dose of oral anticoagulants is reduced, resulting in increased risk of bleeding by overdosing, but also risk of ineffective therapeutics by suboptimal doses. In these conditions we wanted to evaluate the indications and benefits of the treatment with low molecular weight heparin compared with oral anticoagulant therapy in patients with cancer at increased risk of thromboembolic events or who have experienced at least one such event during the course of the disease.
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Materials and method We conducted a review of Anglo-Saxon literature and therapeutic international guidelines, by extensive research of Medline and Pubmed database, using the following search terms: thrombosis, venous thrombosis, cancer, Coumarin, Warfarin, Heparin, Low Molecular Weight Heparin, anticoagulant treatment, anti-thrombosis treatment. There were excluded from the review the articles that we could access only the abstract.
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We have identified major risk factors for thromboembolic events in cancer patients, and therapeutic indications treatment initiation, type of treatment, period of treatment. Results and discussion The optimal approaches for preventing and treating thrombosis remains an open question regarding thromboprophylaxis in high-risk patients, treatment options and optimal treatment period in the acute or recurrent thrombotic events.
Many factors are associated with the risk of developing venous thrombosis and are classified into general causal factors age, previous history of VTE, hospitalization and immobilization for longer than 3 days, major medical conditions, obesity, hereditary thrombophiliacancer related factors primary site - high risk: stomach, pancreas; intermediate risk: lung, lymphomas, gynaecological; low risk: breast, colorectal, head and neck; cancer stage: metastatic 9,10,11 and treatment - related factors: surgery, chemotherapy, hormonal therapy, antiangiogenic agents - bevacizumab, thalidomide, lenalidomide, erythropoiesis stimulating factors, transfusions 9, Recently, in determining the risk of VTE, some biomarkers were associated: leukocyte count, platelet count, low hemoglobin level, high D-dimer level, elevated soluble P-selectin level, high C-protein reactive level 11, In current clinical practice, the routine thromboprophylaxis in ambulatory patients with cancer with chemotherapy,even with high risk factors, is not recommanded.
An exception is made for patients with multiple myeloma who have received thalidomide or lenalidomide and dexamethasone regimens 1,9. The initial therapy of VTE in cancer patients is low-molecular-weight heparin LMWH followed by oral anticoagulant warfarin or related oral anticoagulants.
The long-term use of warfarin or cancer prostate stage 4 life expectancy is problematic due to achieving and maintaining the international normalized ratio INR of The analysis of 33 studies of patients with VTE who received oral anticoagulant therapy longer than 3 months indicates a case fatality for major bleeding of 9. The therapeutic levels in the treatment with oral anticoagulants may not be reached due to drug interactions ex.
But, this were not statistical significant.
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The benefits of using the LMWHs are: more predictable bioavailability, dose-independent renal clearance, not affected by diet, other drugs, anorexia or vomiting; greater flexibility when the treatment must be interrupted, less likely to cause heparin-induced thrombocytopenia 5,9.
The higher cost of the treatment with LMWHs can be annihilated by reducing hospitalization costs necessary to adjust the warfarin dose 3,5.
A statistically significant improvement in overall survival was observed for LMWH relative to placebo. The reduction in mortality was also in favor of LMWH in the subgroup of patients who were identified as having a life expectancy of greater than 6 months A multicentre study demonstrated that a high prophylactic dosage of LMWH UI versus UI increases the protective effect without enhancing the bleeding risk 9, A recent meta-analysis evaluated the anticoagulant treatment on survival in cancer patients without VTE, finding a significant reduction in overall mortality with anticoagulant therapy.
The clinical effect was most pronounced for LMWH, which produced a relative risk reduction in mortality of Conclusion The aim of the anticoagulant treatment in cancer patients is to prevent recurrence, extension and complications of venous thromboembolism while minimizing the risk of major bleeding. In cases carefully selected, long-term therapy with LMWH is the alternative for the oral anticoagulation therapy.
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Bibliografie 1. Arch Intern Med. Linkins L-A. Management of venous thromboembolism in patients with cancer: role of dalteparin.
Vascular Health and Risk Management. Trousseau A. Phlegmasia alba dolens. Clin Med Hotel-dieu Paris.
- Clinical risk profile associated with ovarian cancer Peritoneal cancer chances of survival This study was performed to evaluate the clinical risk profile of patients with ovarian tumors who were surgically treated, measuring the survival rate at 5 years.
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Zacharski LR, Pradoni P. Monreal M. Tissue factor, thrombin, and cancer. Cancer Res. Mandalà M. J Clin Oncol. Lee AY. Sallah S, Husain A, Sigounas V, Plasma coagulation markers in patients with solid tumors and venous thromboembolic disease receiving oral anticoagulation therapy, Clin Cancer Res.
J Clin Oncol ;— Blood;— J Clin Oncol;— Meyer G. Arch Int Med ;— Low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.
J Thromb Haemost ;— Lee AY, Rickles F. Maraveyas, A. Riess H. Stieler J, Oettle H. Bergqvist, David, et al.
- Institute of Oncology Prof.
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