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La revue de médecine interne
Volume 21, n° 3
pages 266-277 (mars 2000)
Received : 9 November 1998 ;  accepted : 8 October 1999
Maladie thromboembolique veineuse et cancer
Venous thromboembolic disease and cancer

C.  Sauve a ,  M.C.  Boffa b ,  G.  Meyer c ,  D.  Farge-Bancel a
aService de médecine interne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France 
bInserm U353, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France 
cService de pneumologie, hôpital Laennec, 42, rue de Sèvres, 75007 Paris, France 

Correspondance et tirés à part : D. Farge-Bancel, même adresse
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Introduction. - La maladie thromboembolique veineuse, sous forme d'une thrombose veineuse périphérique ou d'une embolie pulmonaire, est une complication fréquente chez les patients cancéreux. Elle peut parfois précéder le diagnostic de la néoplasie mais l'intérêt d'une enquête étiologique exhaustive à la recherche d'un cancer devant une manifestation thromboembolique n'est pas démontré.

Actualités et points forts. - De nombreuses anomalies de l'hémostase ont été rapportées dans des études cliniques et biologiques pour expliquer ce phénomène avec, en particulier, la découverte de facteurs procoagulants. Les résultats du traitement anticoagulant classique restent décevants en termes d'efficacité et de tolérance chez ces patients.

Perspectives et projets. - En revanche, les données de la littérature laissent envisager l'intérêt d'une thromboprophylaxie adaptée par héparine de bas poids moléculaire ou par petites doses de warfarine (INR < 2) dans des situations chirurgicales ou médicales spécifiques.

Mots clés  : thrombophlébite ; embolie pulmonaire ; cancer ; facteurs procoagulants.

Abstract

Introduction. - Thromboembolic venous disease, which includes both peripheral venous thrombosis and pulmonary embolism, is a frequent disorder in patients with cancer. Although thromboembolic manifestations may precede the diagnosis of cancer, the value of extensive clinical search for potential underlying cancer when faced with venous thromboembolic manifestations has not been demonstrated.

Current knowledge and key points. - Clinical and biological studies have demonstrated that acquired abnormalities in blood hemostasis, especially procoagulant factors, account for the onset of thromboembolic manifestations in patients with cancer. Classical anticoagulant therapy is associated with low efficacy and tolerance in patients with cancer who are at high risk for hemorrhagic complications and recurrence of thromboembolic disease.

Future prospects and projects. - Recent data suggest the value of anticoagulant therapy using either low molecular weight heparin or warfarin at low doses (INR < 2) according to the specific surgical or medical context.

Mots clés  : thrombophlebitis ; pulmonary embolism ; cancer ; procoagulant factors.

 



© 2000  Éditions scientifiques et médicales Elsevier SAS@@#104156@@

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