İlhan HACIBEKİROĞLU, Ebru SARI, Uğur ERSOY, Dilşen ÇOLAK, G. İnanç İMAMOĞLU, Semiha URVAY, Naziyet KÖSE, Mustafa ALTINBAŞ

Hastalarımızda tromboz sıklığı ve literatürün gözden geçirilmesi

Amaç: Kanser hastaları tromboza eğilimi olan hastalardır. İmmobilizasyon,vasküler obstrüksiyon, cerrahi girişimler, radyoterapi, kemoterapi, kateterler ve kanserin kendisi tromboza neden olmaktadır. Tromboemboli görülme oranları kanserli hastalarda %5 olup, hastanede yatan kanser hastalarında en sık ikinci ölüm nedenidir. Bu bilgilere rağmen günlük pratiğimizde tromboemboli tanı ve tedavisinde karışıklıklar yaşanmaktadır. Bu çalışmanın amacı hastalarımızda tromboemboli insidansını araştırmak ve konuya dikkat çekmektir. Yöntem ve Gereçler: Kliniğimizde Mart 2008 ile Aralık 2011 arasında tedavi ve takibi yapılan 1368 hastanın dosyası retrospektif olarak tarandı. Arteriyel ve venöz tromboemboli gelişen hastaların özellikleri kaydedildi. Bulgular: Dosyası taranan 1368 hastanın 37’sinde (%2.7) tromboemboli saptandı. Bu hastaların 18’i (%48.6) Evre IV hastalığa sahipti. 23 hasta erkek, 14 hasta kadın idi. En çok tromboemboli kolorektal, mide ve pankreas kanseri hastalarında saptandı. Hastalarımızın 24’ünde tromboemboli kemoterapi sırasında veya hemen sonrasında gelişmişti. 15 hasta (%40) 5 Fluorourasil içeren rejim ve altı hasta (%16) sisplatin içeren rejim almakta iken tromboemboli gelişti. Bu hastaların 14’ü (%37) hospitalize idi. Üç hastada pulmoner tromboemboli, altı hastada arteriyel tromboz gelişirken, 28 hastada derin ven trombozu gözlendi. Sonuç: Tromboemboli kanserli hastalarda sağlıklı popülasyona göre artmış olup, tromboza eğilim en fazla abdominal adenokanserler, küçük hücreli akciğer kanseri ve prostat kanserinde görülür. Bazı sitotoksik ajanlarla tromboz eğilimi artar. Özellikle performansı düşük, ek hastalığı olan, hospitalize hastalar tromboemboli riski altındadır ve profilaksi yapılmalıdır. Tromboemboli saptanan hastalar önce tromboz tedavisi almalı ve düzelince tümöre özgü tedavilere geçilmelidir.

Insidence of thromboembolism in our cancer patients: Single center experience and review of the literature

Aim: Venous thromboembolism occurs commonly in patients with cancer. Among risk factors for thromboembolism are long-term immobilisation, especially in hospital, vascular obstruction, surgery, chemotherapy with or without adjuvant hormone therapy and cancer releated peptides. Cancer is associated with a 5-fold risk of thrombosis, and the patients with cancer who develop venous thromboembolism have reduced life expectancy. Despite of this known factors ,there is a mess in diagnosis, prophylaxis and treatment of thromboembolism In this study, we aim to determine insidence of thromboembolism in our patients and to make a point of this topic Material and Methods: In this study, we reviewed the records of 1368 cancer patients followed up in our Medical Oncology Department between March 2008 and October 2011. The records of patients with venous thromboembolism were included in the study. Results: Among 1368 patients we have reviewed, 37 had thromboembolism (%2.7). Eighteen of these patients (%48.6) had metastatic disease. 23 patients were male, 14 patients were female. The most common malignancies associated with thrombosis are those of the colorectal, gastric and pancreas cancer. Thromboembolism were reported in 24 patients during chemotherapy or just after completion of chemotherapy. Most frequently used regimens were 5-FU(n:15, 40%) and cisplatin (n:6,16%) containing regimens. Fourteen patients were inpatient during the event. Among thromboembolism cases, three patients had pulmoner thromboembolism, six patients had arterial thrombosis and 28 patients developed deep venous thrombosis . Discussion: Thromboembolism is a common complication of malignant diseases.The most common malignancies associated with thrombosis are those of the gastrointestinal malignancies, small cell lung cancer and prostat cancer. Some chemotherapy regimens and cytotoxic drugs are espicially thrombogenic. Patients who have comorbidities, immobilized or inpatient , and with poor performance status are under risk of thromboembolic events. So these patients should receive appropriate thromboprophylaxis. Patients who have thromboembolism should receive treatment for thromboembolism before starting specific anticancer treatment.

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