ALTERATION OF COAGULATION AND FIBRINOLYSIS IN MALIGNANCY

Abstract

Malignant diseases occupy a large part in human pathology. According to the World Health Organization,
they are the second leading cause of death in developed countries, giving way only to cardiovascular diseases. In
2020, more than 10 million people worldwide died from malignant diseases. In men, carcinoma of the lung, prostate,
stomach, rectum and colon are most common. In women, breast cancer is the most common, followed by carcinoma
of the skin and cervix. A common complication in cancer patients is thrombosis. Despite the fact that venous
thromboembolism is a major problem in patients with tumor diseases, studies of the prothrombotic state in these
patients have been neglected. More than 130 years ago, the relationship between carcinogenesis and blood
coagulation disorders was established. Abnormalities in coagulation status are found in up to 50% of all patients
with malignant diseases and up to 90% of those with metastases. Thrombosis is the second most common cause of
death in these patients. Clinical symptoms of coagulation disorders are very often the first sign of malignancy.
Tumor growth, procoagulant properties of tumor and inflammatory cells, neoangiogenesis, vascular-endothelial
dysfunction are some of the causes for thrombogenesis in patients with malignant diseases. The impaired function of
the affected organ, decreased coagulation inhibitors, disturbed balance between the systems of coagulation and
fibrinolysis also play important role in the pathogenetic mechanism of thrombosis. The application of
chemotherapeutic drugs can also lead to disorders in hemocoagulation. Thus, coagulopathy and angiogenesis in the
presence of malignancy actually appear to be anatomically and functionally related. They predispose cancer patients
to an increased risk of thrombotic events or bleeding complications. Changes in laboratory parameters that indicate
activation of coagulation and fibrinolysis such as fibrinogen, thrombin-antithrombin complex (TAT), tissue factor
(TF), prothrombin fragment (F1+2), Antithrombin III (AT III), D-dimer and tissue plasminogen activator (t-PA)
have been of increasing interest over the last decade in this pathology. The study of indicators of coagulation
activation and fibrinolysis together with routine hemostasis tests in patients with malignant pathology would allow
finding a marker or a complex of markers that best reflects changes in the hemostasis system and the risk of
thrombotic events. This might be helpful not only to assess the thrombogenic risk, but also for diagnose, treatment
and prevention of thrombotic complications such as deep venous thrombosis or pulmonary embolism. Cancer
patients are at increased risk of thrombosis and furthers studies need to be performed in order to assess the need of
antithrombotic prophylaxis.