ТРОМБОЗЫ И ТРОМБОЭМБОЛИИ В ОНКОЛОГИИ. СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ

Patients with malignant neoplasms are characterized by a high risk of thrombotic complications, which could complicate antitumor treatment and worsen the survival rate. Changes in the hemostatic system, caused by both the tumor and the treatment methods have the main role in the pathogenesis of thrombotic complications in cancer patients. Low molecular weight heparins are the basis for specific prevention of thromboembolic complications in cancer patients. The use of low molecular weight heparins before and after surgery and chemotherapy reduces the activation of intravascular coagulation, reduces the incidence of venous thrombosis and prevent fatal pulmonary embolism, which enhances the antitumor treatment and improves the quality of life in cancer patients.Для больных злокачественными новообразованиями  характерен высокий риск развития тромботических осложнений, которые осложняют противоопухолевое  лечение  и ухудшают выживаемость  онкологических больных. Основную роль в патогенезе тромботических осложнений у больных злокачественными новообразованиями играют изменения в системе гемостаза,  вызываемые как самой опухолью, так и методами лечения. Низкомолекулярные гепарины являются основой специфической профилактики тромбоэмболических  осложнений у онкологических больных. Применение низкомолекулярных гепаринов до и после операции и на фоне химиотерапии уменьшает активацию внутрисосудистого свертывания крови, снижает частоту венозных тромбозов и предотвращает смертельные ТЭЛА, что расширяет  возможности противоопухолевого лечения и повышает качество жизни онкологических больных

Гиперкоагуляция — прогностический фактор, влияющий на эффективность иммунотерапии у больных метастатическим раком почки?

In experimental systems, interference with coagulation can affect tumor biology. Tumor-mediated activation of the hemostatic system has been implicated in both the formation of tumor stroma and the promotion of hematogenous metastasis. We emphasize that hypercoagulation is a frequent symptom in metastatic renal cell carcinoma (MRCC) patients and clinically correlates with progression of the disease. It has been suggested that hypercoagulation is a possible negative predictor for a response to immunotherapy in MRCC patients.

DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME IN SURGICAL TREATMENT OF PATIENTS WITH LIVER MALIGNANCIES

Rationale: Extended resections or extended lobectomies are the most common types of surgical interventions in patients with liver malignancies, and they are associated with serious post-operative complications. Aim: To characterize the role of hemostasis abnormalities in the pathophysiology of post-operative hepatic insufficiency, as well as that of thrombotic and hemorrhagic complications in patients with liver malignancies. Materials and methods: One hundred and twenty patients with liver malignancies were recruited into the study (20  patients with primary hepatic tumors and 100  with colorectal cancer and liver metastases). Extended liver resections (right and left simple and extended lobectomies, both simple and extended) were performed in 100  (84%) of patients; multi-segmental liver resections, in 20  (16%). Assessment of hemostasis was done pre-operatively and at days 1  to 20  after surgery (hemostasis analyzer system STA-R Evolution and Chrono-log aggregometer). Results: After surgical intervention in the liver, subacute disseminated intravascular coagulation (DIC) was found in 34 patients. It was most common (65%) after the right lobectomy and was associated with a  decrease in fibrinogen levels to 121 mg/dL (p<0.01), prothrombin complex factors, to 45%  (р<0.05), antithrombin III to 48%  (р<0.05), with a  significant increase in D dimmer levels of up to 14.5 mcg/mL (р<0.05). Twelve patients with subacute DIC developed deep venous thrombosis of the lower extremities, and 9  patients had severe hepatic insufficiency. Patients with severe hepatic insufficiency had a  statistically significant decrease in prothrombin activity to 45%  (p<0.05), antithrombin III to 44%, plasminogen<50%, with high D dimer (>20  mcl/mL) and von Willebrand factor levels. Conclusion: Surgical interventions in patients with liver malignancy may lead to the development of DIC. Early diagnosis and correction of hemostasis-related risk factors of hepatic insufficiency allows for improvement of the results of surgery in patients with secondary hepatic malignancies

The role of platelets in inflammation and immunity

In recent decades, significant progress has been made in understanding the mechanisms of platelet function and platelet hemostasis correction. Platelets are considered as the most important participants of both normal, and pathological thrombotic process characteristic of the most different diseases and states. In the present review pathophysiological mechanisms of platelet synthesis of various mediators with paracrine effects, which can influence the function of other cells, are consecrated. The physiology of platelets was considered in detail. The leading role of platelets in pathogenesis of the majority of diseases of cardiovascular system as modulators of inflammatory reactions of the immune response which are considered as the leading mechanism of development of atherosclerosis was shown. The ability of platelets to encode inflammatory proteins allowing them to influence adaptive immunity functions was discussed. The role of platelets as a key component of the innate immune system was presented, which is confirmed by the presence of Tolllike receptors (TLR) and glycoproteins, such as integrin αIIbβ3, glycoprotein Ib-IX and FcγRIIa, involved in interaction with bacterial cells. The pathogenesis of the formation of platelet-leukocyte aggregates due to the rapid reversible interaction of P-selectin (CD62P) on the platelet surface with ligand-1 glycoprotein P-selectin (PSGL-1) on the plasma of leukocytes and the mechanism of extracellular neutrophil traps (NETs), as well as the influence of platelets on the function of lymphocytes was presented. The role of platelets in cancer progression, metastasis and thrombosis is considered, and the interrelation of thrombosis and metastasis in malignant diseases was analyzed. The efficiency of the use of antithrombotic drugs in the prevention of thrombosis and, as a consequence, in the prevention of cardiovascular diseases and cancer was discussed

Is hypercoagulation a predictor influencing the efficiency of immunotherapy for metastatic renal cancer?

In experimental systems, interference with coagulation can affect tumor biology. Tumor-mediated activation of the hemostatic system has been implicated in both the formation of tumor stroma and the promotion of hematogenous metastasis. We emphasize that hypercoagulation is a frequent symptom in metastatic renal cell carcinoma (MRCC) patients and clinically correlates with progression of the disease. It has been suggested that hypercoagulation is a possible negative predictor for a response to immunotherapy in MRCC patients

The prospects for using bemiparin in prophylaxis and treatment of thromboses in oncology

Oncological patients have a high risk of thrombotic complications, which worsen the outcomes of antitumor treatment and is one of the leading causes of death. Low molecular weight heparins are the main drugs for the prevention and treatment of thrombotic complications in cancer patients. Zibor (bemiparin) is a second-generation low-molecular-weight heparin (LMWH) that has the lowest molecular weight (3600 Dalton), a half-life increased to 5.3 hours and the highest anti-Factor Xa activity ratio (8:1). In clinical trials, bemiparin has demonstrated high efficacy and safety for prophylaxis and treatment of thromboembolic complications

DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME IN SURGICAL TREATMENT OF PATIENTS WITH LIVER MALIGNANCIES

Rationale: Extended resections or extended lobectomies are the most common types of surgical interventions in patients with liver malignancies, and they are associated with serious post-operative complications. Aim: To characterize the role of hemostasis abnormalities in the pathophysiology of post-operative hepatic insufficiency, as well as that of thrombotic and hemorrhagic complications in patients with liver malignancies. Materials and methods: One hundred and twenty patients with liver malignancies were recruited into the study (20  patients with primary hepatic tumors and 100  with colorectal cancer and liver metastases). Extended liver resections (right and left simple and extended lobectomies, both simple and extended) were performed in 100  (84%) of patients; multi-segmental liver resections, in 20  (16%). Assessment of hemostasis was done pre-operatively and at days 1  to 20  after surgery (hemostasis analyzer system STA-R Evolution and Chrono-log aggregometer). Results: After surgical intervention in the liver, subacute disseminated intravascular coagulation (DIC) was found in 34 patients. It was most common (65%) after the right lobectomy and was associated with a  decrease in fibrinogen levels to 121 mg/dL (p<0.01), prothrombin complex factors, to 45%  (р<0.05), antithrombin III to 48%  (р<0.05), with a  significant increase in D dimmer levels of up to 14.5 mcg/mL (р<0.05). Twelve patients with subacute DIC developed deep venous thrombosis of the lower extremities, and 9  patients had severe hepatic insufficiency. Patients with severe hepatic insufficiency had a  statistically significant decrease in prothrombin activity to 45%  (p<0.05), antithrombin III to 44%, plasminogen<50%, with high D dimer (>20  mcl/mL) and von Willebrand factor levels. Conclusion: Surgical interventions in patients with liver malignancy may lead to the development of DIC. Early diagnosis and correction of hemostasis-related risk factors of hepatic insufficiency allows for improvement of the results of surgery in patients with secondary hepatic malignancies