The management of cancer patients with hemostatic disorders (thrombosis and/or bleeding) faces many clinical challenges.
Patient comorbidities further increase the diagnostic and management difficulties in these patients.
A series of interesting studies on this topic were presented during the "Clinical Challenges" session at the 9th ICTHIC, which stressed the importance of a multidisciplinary approach in managing cancer patients. A complex case was illustrated by Vilaseca1 about a patient from Argentina admitted to the clinic with simultaneous presentation of arterial and venous thrombosis. The postmortem pathological findings confirmed that the patient had an occult liver cancer. Hypercoagulability in cancer patients is well established. Although venous thrombosis is frequently recognized, arterial thrombosis in cancer patients is increasingly reported.
Indeed, the burden of cancer in patients with atrial fibrillation, who are known to have an increased risk for ischemic stroke was demostrated by another study. In a large population of 102,559 patients with atrial fibrillation Atterman2 and colleagues from Sweden investigated the incidence rates of ischemic stroke and compared the risk of stroke between cancer and non-cancer patients. Their findings showed that cancer diagnosis additionally increased the risk of ischemic stroke in atrial fibrillation patients, suggesting that cancer patients with a low stroke risk score may also potentially benefit from anticoagulant treatment.
On the other hand, the studies presented on the issue of venous thrombosis at unusual sites and the risk of cancer, such as the case of retinal vein thrombosis and splanchnic venous thrombosis3,4, concluded that there is still little evidence about the clinical impact and optimal management of cancer associated thrombosis at unusual sites and further studies are needed in these patients.
Finally, the findings on the awareness and understanding of venous thromboembolism in 100 cancer patients randomly selected from the cancer outpatient clinic the Barcelona hospital, presented by Nicolau5, showed a very poor knowledge and awareness of cancer-associated thrombosis among patients. Only 13% of the surveyed patients declared that they were appropriately informed about venous thromboembolism. The development of information and educational programs aimed at raising the awareness on cancer-associated thrombosis, the importance of prevention and early diagnosis are mandatory and essential for improving cancer patient care. Proposals for new approaches in addressing the lack of patient education were presented and should be further discussed.
In summary, owing to its peculiarities cancer-associated thrombosis remains a challenge in a daily clinical practice requiring further insight into clinical and social aspects.
- Vilaseca AB, Pastoriza S, Ameida M. Non-bacterial endocarditis as an initial presentation of a Trousseau's Syndrome? A complex diagnostic challenge. Case report. Thromb Res 2018,164:S208. doi:10.1016/j.thromres.2018.02.062
- Atterman A, Gigante B, Asplund K, Aspberg S. Cancer diagnosis as a risk factor of ischemic stroke in atrial fibrillation patients with low stroke risk score. Thromb Res 2018,164:S209. doi:10.1016/j.thromres.2018.02.064
- Hansen AT, Veres K, Prandoni P, Adelborg K, Soresen HT. Retinal vein thrombosis and risk of cancer: A population-based cohort study. Thromb Res 2018,164:S209. doi:10.1016/j.thromres.2018.02.065
- Gàrcia-Villa A, Yarza R, Pagès M, Díaz-Pedroche C, Font C. Cancer-associated splanchnic venous thrombosis: clinical findings at presentation. Thromb Res 2018,164:S211. doi:10.1016/j.thromres.2018.02.069
- Nicolau B, García-Morillo M, Rodriguez A,García-Villa A, Cortes KS et al. Awareness and understanding of venous thromboembolism in patients with cancer: data on 100 unselected cancer outpatients. Thromb Res 2018,164:S211-12. doi:10.1016/j.thromres.2018.02.070