Pathogenesis of the hypercoagulable state associated with malignancy
- Kenneth A Bauer, MD
Kenneth A Bauer, MD
- Professor of Medicine
- Harvard Medical School
Many patients with cancer are in a hypercoagulable state. The spectrum of manifestations ranges from abnormal coagulation tests in the absence of thrombotic symptoms to massive thromboembolism.
This topic review will discuss the pathogenetic factors that might contribute to the hypercoagulable syndromes that can be associated with malignancy . The contributions of chemotherapeutic drugs to the hypercoagulable state are discussed separately. (See "Drug-induced thrombosis in patients with malignancy".)
The prevention and treatment of hypercoagulable disorders associated with malignancy are discussed separately. (See "Risk and prevention of venous thromboembolism in adults with cancer" and "Treatment of venous thromboembolism in patients with malignancy", section on 'Therapy in special populations' and "Nonbacterial thrombotic endocarditis" and "Drug-induced thrombosis in patients with malignancy".)
The pathogenesis of the hypercoagulable state of malignancy involves the interplay of multiple variables. As an example, intact tumor cells may express procoagulant activity that can directly induce thrombin generation; in addition, normal host tissues may express procoagulant activity in response to the tumor. Comorbid factors such as bed rest, infection, surgery, and drugs, may play a contributory role and may determine whether an asymptomatic increase in coagulability becomes manifest clinically [2,3]. (See "Drug-induced thrombosis in patients with malignancy" and "Overview of the causes of venous thrombosis", section on 'Virchow's triad' and "Overview of the causes of venous thrombosis", section on 'Malignancy' and "Risk and prevention of venous thromboembolism in adults with cancer".)
Thrombotic episodes may precede the diagnosis of malignancy by months or years (see "Overview of the causes of venous thrombosis", section on 'Malignancy') and can present in one of the following ways :
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- MECHANISMS UNDERLYING THE HYPERCOAGULABLE STATE
- Tissue factor
- Tissue factor-bearing microparticles
- Cancer procoagulant
- Procoagulant activities expressed by host tissues
- - Monocytes
- - Platelets
- - Endothelial cells
- - Neutrophils
- TUMOR-SPECIFIC MECHANISMS
- PATIENT COMORBIDITIES