Pathologie-biologie
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Pathologie-biologie · Jun 2008
Review[Treatment of venous thromboembolic disease in cancer patients].
Venous thromboembolism (VTE) disease, as defined by the occurrence of deep venous thrombosis or pulmonary embolism, occurs among 4 to 20% of patients with cancer and is a leading cause of death among these patients. Use of classical anticoagulation to treat VTE in a cancer patient is associated with a higher risk of major bleeding and of VTE recurrence as compared to noncancer patients. Updated comprehensive and systematic review of current data from the medical literature allows to reconsider the classical approach used for anticoagulant treatment in cancer patients and to implement adapted recommendations. ⋯ If LMWH are contra-indicated (renal insufficiency), other therapeutic approaches are warranted, such as use of unfractionated heparin (UFH) with early introduction of anti-vitamin K for at least three months or venous cava filter in case of absolute contra-indications to anticoagulation. VTE prophylaxis in cancer patients relies on the same therapeutic approaches as currently used for noncancer patients at high risk of VTE. The definition of more specific prophylactic approaches for patients with cancer considered at higher risks of VTE, will be the subject of many clinical trials in the forthcoming years.
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Pathologie-biologie · Jun 2008
Review[Venous thromboembolism associated with long-term use of central venous catheters in cancer patients].
Increased incidence of cancers and the development of totally implanted venous access devices that contain their own port to deliver chemotherapy will lead to a greater than before numbers of central venous catheter-related thrombosis (CVCT). Medical consequences include catheter dysfunction and pulmonary embolism. Vessel injury caused by the procedure of CVC insertion is the most important risk factor for development of CVCT. ⋯ Long-term LMWH that has been shown to be more effective than oral anticoagulant in cancer patients with lower limb DVT, could be used in these patients. The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established and the last recommendations suggest that clinicians not routinely use prophylaxis to try to prevent thrombosis related to long-term indwelling CVCs in cancer patients. Additional studies performed in high risk populations with appropriate dosage and timing will help to define which patients could benefit from prophylaxis.
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Pathologie-biologie · Jun 2008
Review[Occult cancer and venous thromboembolism: which screening in patients with inaugural deep vein thrombosis?].
The association between thrombosis and cancer, initially evidenced in metastatic patients is well recognized and now described in patients with occult cancer where venous thrombosis may be the first clinical manifestation (Trousseau's syndrome). In this review, clinical and epidemiological interactions between thrombosis and cancer are described in five distinct step: venous thrombosis during malignancy and occult cancer, period of large increased in the risk for diagnosis of cancer, patients or venous thrombosis with increased risk for occult cancer, extensive or not extensive screening for occult cancer, earlier occult cancer detection associated or not with improved treatment possibilities and thus prognosis.