Thrombosis is one of the relevant complications of tumor disease. But what exactly is the impact of cancer in inducing embolic disorders? Can we prevent it? We talked about this at an online meeting organized by the Spanish Heart Foundation (FEC) and the Spanish Association Against Cancer (AECC) in which Dr. José Luis Palma Gámiz, vice president of the FEC, explained that tumor patients have a greater chance of dying from cardiovascular causes, it is estimated that around 30% more.
In fact, venous thrombotic disease is the second leading cause of preventable death in cancer patients. This was stated by Dr. Cristina Pascual, a hematologist at the Gregorio Marañón University Hospital in Madrid, who added that deep vein thrombosis and pulmonary embolism are the most common complications in cancer patients. So much so that one in five cases of deep vein thrombosis or pulmonary embolism occurs in people with active cancer.. It appears more easily in the most advanced stages of the neoplasm, but sometimes it can be the first symptom or the only symptom of a tumor that has not yet shown its face. And although age is a risk factor, young patients can also be affected: one in 10 cancer patients who dies from a pulmonary embolism is under 50 years of age.
However, the risk of developing venous thrombotic disease is not the same in all cancer patients or in every patient over time. In addition to age, factors such as obesity, a sedentary lifestyle, a previous history of thrombotic disease, the treatments applied to the patient, the type of neoplasm, the location and the type of tumorcan promote thrombotic disease. Regarding the latter, Dr. Pascual highlighted that tumors of the pancreas, brain, stomach and lung are those with the highest incidence of venous thrombotic disease. On the other hand, it is less frequent in breast tumors. And as for the venous territory that can be affected, although the highest incidence is related to the lower limbs and the lung, it can also occur in the upper limbs and in the area associated with the catheter, while other less frequent territories are those related to the abdominal venous system.
How to prevent
Can we prevent the appearance of these thrombotic events and thus avoid complications? The response of Dr. Teresa López, a cardiologist at the La Paz University Hospital in Madrid, is that it is possible to manage this risk. As indicated at this meeting, held in collaboration with Daiichi-Sankyo, primary prevention strategies involve starting anticoagulant treatment before or immediately after a tumor is diagnosed, while, if we talk about secondary prevention, treatment is started once once the thrombotic event has occurred with the intention of preventing it from happening again and minimizing the consequences.
Depending on this, different types of drug doses will be used, lower when we want to prevent the problem and higher when the objective is to treat that problem. “The treatment will depend on what the cancer is, what stage it is in, what the risk of thrombosis is compared to hemorrhage, what treatment the patient is receiving, what interactions may occur, what duration is expected for the treatment you are receiving and also the preferences of the patient. That is why many specialists are involved in the treatment of cancer-associated thrombosis : hematologists, oncologists, internists, cardiologists and primary care physicians,” he explained.
As for what these treatments consist of, Dr. López indicated that there are two basic ones: subcutaneous heparins and direct oral anticoagulants . The latter have a better efficacy profile in cancer patients with respect to preventing recurrences of thromboembolic events and the same risk of major bleeding, but a little more in some minor bleeding scenarios. “In all cases, the risk of thrombosis and the risk of hemorrhage must be balanced, since, for example, patients who have tumors that affect the mucosa have a higher risk of hemorrhage,” she pointed out.
In addition, as Teresa de León Méndez, a nurse at the Spanish Association Against Cancer in Madrid, recalled, to prevent thrombosis in cancer patients, exercise, quitting smoking and following a healthy diet are also necessary . However, although this lifestyle reduces the chances of thrombotic disease, it is important to be alert to the possibility of a thrombus appearing, for which it is essential to recognize its symptoms. “The most common signs are swelling and pain in the affected area, as well as feeling hot or having redness in that area. If any of these symptoms appear, the first thing is to go to the doctor, who, if the thrombus is confirmed, will prescribe a medication that is very important to follow, ”she indicated.
