Abstract A46: The evidence base for the risk and management of thrombosis in hematological malignancy patients
Authors: Hassan Fathelrahman M. 
Published: May 2012

Background: The inflammatory response enhances the prothrombotic process via the action of potent inflammatory mediators, which induce further expression of procoagulants from tumor cells, activate platelets and induce endothelial expression of prothrombotic factors. Cancer treatment interventions, including surgery, chemotherapy, radiotherapy and the use of central venous catheters, all promote thrombosis, as does venous stasis due to restricted mobility and/or compression of vessels by a large tumor bulk.

Objectives: 1. To evaluate of hypercoagulable state and tumor procoagulant activity in hematological malignancies patients and 2. to address the primary thromboprophylaxis in medically managed, the optimum management of VTE and the prevention and treatment of VTE associated with central venous catheters.

Materials and Methods: Paper-based reply-paid questionnaire was distributed between patients, included the information about the duration, treatment used, sex, age, and type of malignant. We respectively analyzed 96 hematological malignancies patients treated for the prevention of recurrent venous thromboembolism and 33 control groups.the clinical analysis included thrombotic markers (protein S, protein C, PF1.2, TAT, PAI-1 and fibrin D-dimer) were done to all patients and control. Low-molecular weight heparin (LMWH) versus Oral anticoagulant frequency distribution were compared between cases and controls using statistical analysis.

Results: In total, 93 completed questionnaires were returned, respondents were reported the routine treatment of more than 10 types of haemopatopoietic and lymphoid tissues tumors. Of these, CML and CLL were most commonly treated (by 45%–62% of respondents), with lymphoma, plasma cell myeloma, AML, polythycythemia vera, and mast cell sarcoma the next most common (treated by 26%–38% of respondents). Most of patients (76%) showed a markedly elevation of PAI-1 and D-dimer and significantly elevated in whose treated surgically, while the other thrombotic markers (protein S, protein C, PF1.2, TAT were normal compared to control groups. 11% of 93 respondents who treat this tumor type surgically and 88% who treat it medically rated the risk of VTE as greater than 19%. Depending upon whether patients were managed surgically or medically, where most medically treated cancer patients were thought to have low risks, below 9%. The results showed that the LMWHs are effective for thromboprophylaxis in hematological malignance patients (56%) undergoing surgery and with central venous catheters, and for the initial treatment of VTE in cancer compared to oral anticoagulants.

Thromboprophylaxis was significantly more common for patients receiving chemotherapy for advanced disease (33% of respondents) than for those receiving adjuvant chemotherapy (12%) or undergoing surgery (3%).

Conclusion: There are several problems associated with the treatment of VTE in patients, especially with the use of oral anticoagulants, the onset of hypercoagulability, and raised risk of VTE. The true incidence of thrombosis by tumor type, stage of disease and antitumor intervention in the out-of-hospital cancer population is unknown.

Citation Information: Cancer Prev Res 2010;3(1 Suppl):A46.