Colorectal cancer (CRC), results in a hypercoagulable state which manifests clinically as venous thromboembolism (VTE), often presenting as a deep vein thrombosis (DVT) or pulmonary embolism (PE). The consequences of VTE in CRC can be devastating, resulting in long-term morbidity and are a frequent cause of death, even amongst those who would have otherwise had a favourable cancer prognosis.
The incidence of VTE in all cancers is increasing, whilst the exact incidence of VTE in CRC is likely to be underestimated. All cancer treatments increase the risk of VTE in an already at risk population.
CRC-associated VTE is a challenging entity to manage with recurrences occurring more frequently in cancer patients, despite anticoagulation. Anticoagulation, whether treatment or prophylactic, increases the risk of bleeding, especially in patients with cancer. Although strong evidence underpins the initial management of cancer-associated VTE, there is uncertainty with regard optimum treatment duration. For VTE prevention, extended (28 days), pharmacological thromboprophylaxis post CRC surgery is internationally recommended. Pharmacological thromboprophylaxis is not routinely recommended for nonhospitalised patients receiving chemotherapy.
There is growing evidence of a symbiotic relationship between cancer biology and the clotting system. Tissue factor (TF), the initiator of the clotting pathway, promotes cancer via clotting dependent and independent mechanisms. Clotting pathway factors, including TF, may have utility as biomarkers in CRC, for assessment of VTE risk in addition to cancer prognosis. The clotting system may also be a target for potential anti-cancer therapies, either via existing anticoagulants or experimental direct TF inhibitors.
Ervik M, Lam F, Ferlay J, Mery L, Soerjomataram I, Bray F (2016) Cancer Today. International Agency for Research on Cancer. http://gco.iarc.fr/today. Accessed 10/01/2017 2017
Alcalay A, Wun T, Khatri V, Chew HK, Harvey D, Zhou H, White RH (2006) Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24(7):1112–1118. https://doi.org/10.1200/JCO.2005.04.2150 CrossRef
Colorectal Writing Group for the Surgical C, Outcomes Assessment Program–Comparative Effectiveness Research Translation Network C (2015) Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA surgery 150(8):712–720. https://doi.org/10.1001/jamasurg.2015.1057 CrossRef
den Exter PL, Hooijer J, Dekkers OM, Huisman MV (2011) Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol 29(17):2405–2409. https://doi.org/10.1200/jco.2010.34.0984 CrossRef
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Prestrud AA, Falanga A, American Society of Clinical Oncology Clinical P (2013) Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31(17):2189–2204. https://doi.org/10.1200/JCO.2013.49.1118 CrossRef
Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, Girolami A (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100(10):3484–3488. https://doi.org/10.1182/blood-2002-01-0108 CrossRefPubMed
Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M, Randomized comparison of low-molecular-weight heparin versus oral anticoagulant therapy for the prevention of recurrent venous thromboembolism in patients with cancer I (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(2):146–153. https://doi.org/10.1056/NEJMoa025313 CrossRefPubMed
Khorana AA, Kamphuisen PW, Meyer G, Bauersachs R, Janas MS, Jarner MF, Lee AY (2016) Tissue factor as a predictor of recurrent venous thromboembolism in malignancy: biomarker analyses of the CATCH trial. J Clin Oncol 35(10):1078–1085
- Colorectal cancer and thrombosis
P. A. Rees
H. W. Clouston
C. C. Kirwan
- Springer Berlin Heidelberg
Neu im Fachgebiet Chirurgie
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