Advertisement

Der Internist

, Volume 46, Issue 1, pp 48–56 | Cite as

Hämostasestörungen bei onkologischen Patienten

  • M. von Depka ProndzinskiEmail author
Schwerpunkt: Onkologische Notfälle
  • 124 Downloads

Zusammenfassung

Onkologische Patienten erleiden häufig Hämostasestörungen, die sich als akutes thromboembolisches Ereignis, als disseminierte intravasale Gerinnungsaktivierung aber auch als hämorrhagische Diathese manifestieren können. In jedem Fall stellen diese Störungen eine ernste Herausforderung dar, die mit erhöhter Morbidität und Mortalität einhergehen und häufig ein interdisziplinäres Vorgehen verlangen. In diesem Artikel werden die tumorassoziierte Thrombophilie, die disseminierte intravasale Gerinnungsaktivierung als prokoagulatorische Störungen sowie das erworbene Von Willebrand-Syndrom und die Thrombozytopenie als typische hämorrhagische Diathesen onkologischer Patienten hinsichtlich Pathophysiologie, Diagnostik und Therapie dargestellt und diskutiert.

Schlüsselwörter

Gerinnungsstörungen Hämostasestörungen Hämorrhagische Diathese Thrombophilie Onkologie 

Disorders of coagulation in oncological patients

Abstract

Patients with malignancies often experience acute disorders of coagulation. They may manifest as thromboembolism, disseminated intravascular coagulation or a tendency to bleed. Either disorder carries a high rate of complications and a difficult task in diagnosing and treating them. Some complications typical for patients with malignancies are discussed. Among these are tumor associated thrombophilia, acquired von Willebrand’s disease, and thrombocytopenia.

Keywords

Coagulation disorders Bleeding Thrombophilia Oncology Von Willebrand’s disease 

Notes

Interessenkonflikt:

Keine Angaben

Literatur

  1. 1.
    Rickles FR, Levine MN (2001) Epidemiology of thrombosis in cancer. Acta Haematol 106: 6–12PubMedGoogle Scholar
  2. 2.
    Edwards RL, Silver J, Rickles FR (1993) Human tumor procoagulants: registry of the Subcommittee on Haemostasis and Malignancy of the Scientific and Standardization Committee, International Society on Thrombosis and Haemostasis. Thromb Haemost 69: 205–213PubMedGoogle Scholar
  3. 3.
    Donati MB, Falanga A, Consonni R et al. (1990) Cancer procoagulant in acute non lymphoid leukemia: relationship of enzyme detection to disease activity. Thromb Haemost 64: 11–16PubMedGoogle Scholar
  4. 4.
    Levitan N, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, Rimm AA (1999) Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore) 78: 285–291Google Scholar
  5. 5.
    Rickles FR, Patierno S, Fernandez PM (2003) Tissue factor, thrombin, and cancer. Chest 124 [Suppl]: 58S–68SPubMedGoogle Scholar
  6. 6.
    Kwaan HC, Parmar S, Wang J (2003) Pathogenesis of increased risk of thrombosis in cancer. Semin Thromb Hemost 29: 283–290PubMedGoogle Scholar
  7. 7.
    Carroll VA, Binder BR (1999) The role of the plasminogen activation system in cancer. Semin Thromb Hemost 25: 183–197PubMedGoogle Scholar
  8. 8.
    Nicolaides AN, Breddin HK, Fareed J et al.; Cardiovascular Disease Educational and Research Trust and the International Union of Angiology (2001) Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 20: 1–37Google Scholar
  9. 9.
    Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H (2001) Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 88: 913–930PubMedGoogle Scholar
  10. 10.
    Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F; ENOXACAN II Investigators (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346: 975–980CrossRefPubMedGoogle Scholar
  11. 11.
    Bern MM, Lokich JJ, Wallach SR et al. (1990) Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med 112: 423–428PubMedGoogle Scholar
  12. 12.
    Monreal M, Alastrue A, Rull M, Mira X, Muxart J, Rosell R, Abad A (1996) Upper extremity deep venous thrombosis in cancer patients with venous access devices—prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost 75: 251–253PubMedGoogle Scholar
  13. 13.
    Meier CR, Jick H (1998) Tamoxifen and risk of idiopathic venous thromboembolism. Br J Clin Pharmacol 45: 608–612Google Scholar
  14. 14.
    Ornstein DL, Zacharski LR (2000) Cancer, thrombosis, and anticoagulants. Curr Opin Pulm Med 6: 301–308PubMedGoogle Scholar
  15. 15.
    Prandoni P, Lensing AW, Piccioli A et al. (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100: 3484–3488PubMedGoogle Scholar
  16. 16.
    Levine MN, Lee AY, Kakkar AK (2003) From Trousseau to targeted therapy: new insights and innovations in thrombosis and cancer. J Thromb Haemost 1: 1456–1463PubMedGoogle Scholar
  17. 17.
    Meyer G, Marjanovic Z, Valcke J et al. (2002) Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 162: 1729–1735CrossRefPubMedGoogle Scholar
  18. 18.
    Hettiarachchi RJ, Smorenburg SM, Ginsberg J, Levine M, Prins MH, Buller HR (1999) Do heparins do more than just treat thrombosis? The influence of heparins on cancer spread. Thromb Haemost 82: 947–952PubMedGoogle Scholar
  19. 19.
    Gross PL, Aird WC (2000) The endothelium and thrombosis. Semin Thromb Hemost 26: 463–478PubMedGoogle Scholar
  20. 20.
    Fisher CJ, Yan SB (2000) Protein C levels as a prognostic indicator of outcome in sepsis and related diseases. Crit Care Med 28 [Suppl]: S49–56PubMedGoogle Scholar
  21. 21.
    Kumar S, Pruthi RK, Nichols WL (2002) Acquired von Willebrand disease. Mayo Clin Proc 77: 181–187PubMedGoogle Scholar
  22. 22.
    Mannucci PM (2004) Treatment of von Willebrand’s disease. N Engl J Med 351: 683–694PubMedGoogle Scholar
  23. 23.
    Slichter SJ (2004) Relationship between platelet count and bleeding risk in thrombocytopenic patients. Transfus Med Rev 18: 153–167PubMedGoogle Scholar
  24. 24.
    Gaydos LA, Freireich EJ, Mantel N (1962) The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med 266: 905–909PubMedGoogle Scholar
  25. 25.
    Friedmann AM, Sengul H, Lehmann H, Schwartz C, Goodman S (2002) Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylactic platelet transfusions. Transfus Med Rev 16: 34–45PubMedGoogle Scholar
  26. 26.
    Goodnough LT (2003) Risks of blood transfusion. Crit Care Med 31 [Suppl]: S678–686CrossRefPubMedGoogle Scholar
  27. 27.
    Taylor FB, Toh CH, Hoots WK, Wada H, Levi M (2001) Scientific Subcommittee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis ISTH Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 86: 1327–1330PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Abteilung Hämatologie, Hämostaseologie und OnkologieMedizinische Hochschule Hannover
  2. 2.Abteilung Hämatologie, Hämostaseologie und OnkologieMedizinische HochschuleHannover

Personalised recommendations