Catastrophic Arteriovenous Thromboembolism as Initial Manifestation of Pancreatic Cancer
Context The association between cancer and thrombosis is well-known. Among gastrointestinal malignancies, pancreatic cancer has perhaps the strongest association with thromboembolic events. However, simultaneous arterial and venous thromboses affecting multiple organs at the time of initial diagnosis is rare, with an incidence of less than 1%. Case report We report herein a case of a 61-year-old woman who presented with digital ischemia, a non-ST elevation myocardial infarction and an ischemic stroke, along with deep vein thromboses and pulmonary embolism. She was subsequently diagnosed with metastatic pancreatic cancer. Discussion This report highlights the intriguing association between pancreatic cancer biology, tumor metastases, and triggering of venous and arterial thromboembolic events. Current evidence points towards early thromboembolic phenomena as a harbinger of poor outcome in pancreatic cancer, and studies attempting to define the role of prophylactic anticoagulation in these patients are ongoing.
Khorana AA, Fine RL. Pancreatic cancer and thromboembolic disease. Lancet Oncol 2004;5:655-63.
Epstein AS, Soff GA, Capanu M, et al. Analysis of incidence and clinical outcomes in patients with thromboembolic events and invasive exocrine pancreatic cancer. Cancer 2011 doi:10.1002/cncr.26600
Khorana AA, Francis CW, Culakova E, et al. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol 2006;24:484-90
Shah MM, Saif MW. Pancreatic cancer and thrombosis. Highlights from the "2010 ASCO Annual Meeting". Chicago, IL, USA. June 4-8, 2010. JOP 2010;11:331-3
Kakkar AK, Chinswangwatanakul V, Tebbutt S, et al. A characterization of the coagulant and fibrinolytic profile of human pancreatic carcinoma cells. Haemostasis 1998;2:1–6
Wahrenbrock M, Borsig L, Le D, et al. Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. J Clin Invest 2003;112:853–62
Varki A. Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood 2007;110(6):1723-9
Maraveyas A, Waters J, Roy R, et al. Gemcitabine versus gemcitabine plus dalteparin thromboprophylaxis in pancreatic cancer. Eur J Cancer 2011 [PMID 22100906]
Copyright (c) 2014 Shounak Majumder, Tatiana Thom, Constantin A Dasanu
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