Bleeding and thrombotic complications are important causes of morbidity and mortality in critically ill patients with cancer. The prevalence of these complications has increased progressively in recent years as a result of improvements in cancer treatment, which increase the exposure of patients to these risks, and of advances in critical care. The exact incidence of bleeding in patients with cancer admitted to the intensive care unit (ICU) is not known. In general, bleeding complications occur relatively infrequently in patients with solid tumors other than malignant melanoma, germ cell tumors, and prostate cancer.<sup>50 Goad K.E., Gralnick H.R. Coagulation disorders in cancer Hematol Oncol Clin North Am 1996 ;  10 : 457  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 53 Graus F., Rogers L.R., Posner J.B. Cerebrovascular complications in patients with cancer Medicine (Baltimore) 1985 ;  64 : 16

Cliccare qui per andare alla sezione Riferimenti, 130 Slichter S.J., Harker L.A. Hemostasis in malignancy Ann N Y Acad Sci 1974 ;  230 : 252  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 132 Sun N.C., McAfee W.M., Hum G.J. , e al. Hemostatic abnormalities in malignancy, a prospective study of one hundred eight patients. Part I. Coagulation studies Am J Clin Pathol 1979 ;  71 : 10

Cliccare qui per andare alla sezione Riferimenti</sup> Bleeding is common in patients with leukemias, particularly in patients with acute promyelocytic leukemia as many as 90% of whom may develop hemorrhage.<sup>6 Auger M.J., Mackie M.J. Haemostasis in malignant disease J R Coll Physicians Lond 1988 ;  22 : 74

Cliccare qui per andare alla sezione Riferimenti, 90 Lisiewicz J. Mechanisms of hemorrhage in leukemias Semin Thromb Hemost 1978 ;  4 : 241

Cliccare qui per andare alla sezione Riferimenti, 115 Rickles F.R., Levine M., Edwards R.L. Hemostatic alterations in cancer patients Cancer Metastasis Rev 1992 ;  11 : 237  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Hemostatic changes leading to a prothrombotic state may occur in more than 90% of patients with cancer.<sup>115 Rickles F.R., Levine M., Edwards R.L. Hemostatic alterations in cancer patients Cancer Metastasis Rev 1992 ;  11 : 237  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In addition, venous thromboembolism is encountered at postmortem examination in approximately 50% of patients with cancer.<sup>41 Francis J.L., Biggerstaff J., Amirkhosravi A. Hemostasis and malignancy Semin Thromb Hemost 1998 ;  24 : 93  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>

The practice of critical care oncology requires that the intensivist have a working knowledge of the various hemostatic reactions that occur in acutely ill patients with cancer. This article reviews the physiology of normal hemostasis and then discusses the relationship of the coagulation system and cancer. The pathophysiology of bleeding and thrombosis in the patient with cancer are reviewed along with the diagnostic and treatment approaches to the disorders most frequently encountered in patients with cancer admitted to the ICU. Finally, the potential usefulness of recombinant factor VII concentrate, a novel clotting agent, in patients with cancer is reviewed.