Dysregulated hemostasis in cancer patients is associated with various clinical conditions, from thromboembolic complications to disseminated intravascular coagulation. Despite the well-established association between cancer and thromboembolic complications, the mechanisms involved are not completely elucidated. There are several predisposing factors in cancer for increased thrombus generation, such as immobilization and chemotherapy. The term cancer-associated thrombosis (CAT) has been introduced to describe the close bidirectional relationship between cancer and thromboembolic events. Conventional coagulation tests (PT/aPTT) are more accurate in detecting a hypocoagulable rather than a hypercoagulable state; thus, their contribution to CAT management is limited. Traditionally, D-dimer levels have been the most common laboratory study for the evaluation of thrombotic risk. However, D-dimer levels only display a snapshot of the coagulation cascade, and they cannot provide a dynamic evaluation of evolving clot formation. Non-conventional assays, such as viscoelastic methods and microparticle formation are promising tools for the identification of patients at risk for developing CAT. Recent guidelines from the American Society of Clinical Oncology counsel against the estimation of thrombotic risk through a single test and recommend the use of scoring systems that take into account several risk factors. The present review outlines the current insights into the pathophysiological mechanisms of CAT and provides a comprehensive review of the latest advances in the laboratory assessment of CAT and the recent guidelines for the management of patients at risk for developing thromboembolic complications.
癌症患者体内止血功能失调与多种临床状况相关，从血栓栓塞并发症到弥散性血管内凝血不等。尽管癌症与血栓栓塞并发症之间的关联已得到充分证实，但其涉及机制尚未完全阐明。癌症中存在多种促进血栓生成的因素，如长期卧床和化疗。癌症相关血栓形成这一术语的提出，旨在描述癌症与血栓栓塞事件之间密切的双向关联。传统凝血检测（凝血酶原时间/活化部分凝血活酶时间）在检测低凝状态方面比高凝状态更为准确，因此对癌症相关血栓形成管理的贡献有限。传统上，D-二聚体水平一直是评估血栓形成风险最常见的实验室指标。然而，D-二聚体水平仅能反映凝血级联反应的瞬时状态，无法对动态发展的血栓形成过程进行评估。非常规检测方法，如粘弹性检测和微粒形成检测，是识别癌症相关血栓形成风险患者的有前景的工具。美国临床肿瘤学会最新指南建议不应通过单一检测评估血栓形成风险，推荐采用综合多种风险因素的评分系统。本综述概述了当前对癌症相关血栓形成病理生理机制的认识，全面回顾了实验室评估癌症相关血栓形成的最新进展，以及针对血栓栓塞并发症风险患者管理的最新指南。
Cancer-Associated Thrombosis: Pathophysiology, Laboratory Assessment, and Current Guidelines
肿瘤(癌症)患者之家