Acquired and inherited risk factors for developing venous thromboembolism in cancer patients receiving adjuvant chemotherapy: a prospective trial.

BACKGROUND: Acquired and inherited risk factors for venous thromboembolism (VTE) and the incidence of symptomatic VTE were investigated in patients on adjuvant chemotherapy for breast or gastrointestinal cancer (GI). PATIENTS AND METHODS: In a prospective observational study (January 2003 and February 2006), 199 GI (82 women/117 men; age range, 26-84 years) and 182 breast (180 women/2 men; age range, 29-85 years) cancer patients were enrolled and followed-up for symptomatic VTE during adjuvant chemotherapy. The effect of acquired (i.e. age, chemotherapy, tumour histotype, history of thrombosis, body mass index and smoking) and inherited risk factors [i.e. antithrombin, protein C (PC), protein S, homocysteine, activated PC resistance, factor V Leiden (FVL) and prothrombin (PT) mutations) was prospectively evaluated. RESULTS: Overall, 30 VTE events (7.87%) were recorded: 28 (7.35%) during treatment and 2 (0.52%) during the subsequent follow-up. Among all the 381 cancer patients, FVL was detected in 14 cases (3.67%) and PT mutation in 10 cases (2.62%). Multivariate analysis showed a significant association between the development of VTE and both thrombocytosis [hazard ratio (HR) 1.65; 95% confidence interval (CI), 1.04-2.637, P <0.0341] and a prior episode of thrombosis (HR 7.6; 95% CI, 1.77-33.1, P <0.006). FVL and PT mutations were not associated with the risk for VTE. CONCLUSION: The present data indicate thrombocytosis and history of thrombosis as risk factors for development of a thrombotic event during adjuvant chemotherapy in patients with malignant diseases.

Left ventricular function in chronic anemia: evidence of noncatecholamine positive inotropic factor in the serum.

The enhanced left ventricular (LV) performance observed in anemia has been attributed to changes in preload and afterload. Whether there is a concomitant increase in contractility is controversial. Seventeen patients with chronic anemia (hematocrit range 17 to 30%) and 17 control subjects, matched by age and sex, were studied. In 10 patients and 10 control subjects (group I), a noninvasive evaluation of LV function through M-mode echocardiography and cuff blood pressure recording was performed. In patients with anemia, stroke volume increased 43% (p less than 0.01), fractional shortening 21% (p less than 0.001), and mean rate of circumferential shortening 32% (p less than 0.001). In patients with anemia, end-systolic stress decrease 27% (p less than 0.05) and diastolic blood pressure 21% (p less than 0.001). The effect of serum from these patients and control subjects on the development of isometric tension by isolated cat papillary muscles was assessed compared with the basal (Ringer-Locke bath) values. Anemia serum increased maximal developed tension 21% and maximal rate of tension development 20% relative to basal levels. These changes were significantly higher (p less than 0.001) than the increases produced by control serum (8% and 7%, respectively). In the 7 patients with anemia in group II and their matched controls, the in vitro isometric tension characteristics were assessed before and after blocking beta adrenoreceptors with propranolol, 10(-6) M. The observed increase in the developed tension persisted after beta blockade, as well as the enhancement of the maximal rate of tension development. Plasma catecholamine levels in this group II were within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Enfermedad veno-oclusiva hepática, colitis ulcerosa idiopática y trombosis portal: comunicación de un caso clínico / Hepatic veno-occlusive disease, idiopathic ulcerative colitis and portal thrombosis. Report of one case

We report a previously healthy 29 years old man, presenting with a sudden episode of abdominal pain, mild jaundice, hepatomegaly and ascites. Magnetic resonance imaging study and liver biopsy were compatible with veno-occlusive disease. Incidentally, an ulcerative colitis and portal vein thrombosis were diagnosed. Anticoagulant treatment was started, with good clinical and radiological response. Veno-occlusive disease of the liver must be suspected In cases of liver failure and ascites associated to procoagulant conditions.