Disseminated Intravascular Coagulation in Cancer: An Update
Disseminated Intravascular Coagulation in Cancer: An Update
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DOI：
10.1055/s-0039-1687890
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发表时间：
2019-06-01
影响因子：
5.7
通讯作者：
Levi, Marcel
中科院分区：
文献类型：
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作者：
Levi, Marcel
癌症通常导致凝血激活，表现为最极端形式的弥散性血管内凝血（DIC）。DIC的特征是全身性血管内凝血激活（导致血管内血小板和纤维蛋白沉积）以及凝血蛋白和血小板的同时消耗（可能导致出血并发症）。恶性肿瘤患者的DIC临床病程通常不如DIC并发其他临床情况（包括感染或创伤性损伤后的全身炎症反应）严重。进展缓慢、不太剧烈和广泛的止血紊乱可保持无症状。最终，持续的消耗可能导致血小板和凝血因子水平降低，出血并发症（通常位于肿瘤部位或远处转移）可能是DIC的第一个临床表现。另一种临床情况主要是血栓性并发症，从临床上明显的血管血栓形成到微血管血小板栓塞。DIC管理的主要原则是对突发性疾病进行充分治疗;然而，有些临床表现可能需要额外的支持性策略，专门针对改善凝血功能障碍。
Cancer often leads to the activation of coagulation, manifesting as disseminated intravascular coagulation (DIC) in its most extreme form. DIC is characterized by systemic intravascular coagulation activation (leading to deposition of intravascular platelets and fibrin) and simultaneous consumption of coagulation proteins and thrombocytes (which may cause bleeding complications). The clinical course of DIC in patients with malignancies is typically less intense compared with DIC complicating alternative clinical settings, including systemic inflammatory responses following infection or traumatic injury. A more slowly proceeding, less fulminant, and widespread hemostatic derangement can remain asymptomatic. Eventually, the ongoing consumption may result in low levels of platelets and coagulation factors, and bleeding complications (frequently localized at the site of the tumor or distant metastases) may be the first clinical manifestation of DIC. An alternative clinical scenario is dominated by thrombotic complications, ranging from clinically manifest vascular thrombosis to microvascular platelet plugs. The main principle of DIC management is adequate treatment of the precipitating disorder; however, there are clinical presentations that may require additional supportive strategies specifically aimed at the amelioration of the coagulopathy.