Enfermedad tromboembólica venosa idiopática como manifestación inicial de cáncer oculto
¿Cuán extenso debe ser el screening paraclínico en estos pacientes?
Palabras clave:
TROMBOEMBOLIA VENOSA, NEOPLASIAS
Resumen
La enfermedad tromboembólica venosa idiopática es una frecuente forma de manifestación inicial de un cáncer aparentemente oculto. Este escenario es un desafío para el médico clínico que deberá seleccionar una estrategia diagnóstica para la búsqueda de dicho tumor oculto. El objetivo del presente trabajo es, en base a los conocimientos actuales, recomendar un esquema de estudio de estos pacientes intentando diagnosticar la mayor parte de tumores sin producir iatrogenia en el intento. Esta revisión inicia su encabezado con una viñeta clínica muy breve, la cual únicamente busca ilustrar una situación clínica habitual y ubicar al lector en el contexto al que se hace referencia. Luego se revisa la evidencia científica disponible a la fecha para conceptualizar el marco teórico del cual se desprenden las recomendaciones finales.
Citas
(1) Bülller HR. Has time come for screening for occult cancer in patients with venous thromboembolism? J Thromb Haemost 2004; 2(6): 874-5.
(2) Levine M. Treatment of thrombotic disorders in cancer patients. Haemostasis 1997; 27(Suppl 1): 38-43.
(3) Murchison JT, Wylie L, Stockton DL. Excess risk of cancer in patients with primary venous thromboembolism: a national, population-based cohort study. Br J Cancer 2004; 91(1): 92-5.
(4) Prandoni P, Piccioli A. Thrombosis as a harbinger of cancer. Curr Opin Hematol 2006, 13(5): 362-5.
(5) White RH, Chew HK, Zhou H, Parikh-Patel A, Harris D, Harvey D, et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med 2005; 165(15): 1782-7.
(6) Iodice S, Gandini S, Löhr M, Lowenfels AB, Maisonneuve P. Venous thromboembolic events and organ-specific occult cancers: a review and meta-analysis. J Thromb Haemost 2008; 6(5): 781-8.
(7) Sørensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998; 338(17): 1169-73.
(8) Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancer associated venous thromboembolism. N Engl J Med 2000; 343(25): 1846-50.
(9) Piccioli A, Prandoni P. Screening for occult cancer in patients with idiopathic venous thromboembolism: yes. J Thromb Haemost 2003; 1(11): 2271-2.
(10) Monreal M, Lensing AW, Prins MH, Bonet M, Fernández-Llamazares J, Muchart J, et al. Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism. J Thromb Haemost 2004; 2(6): 876-81.
(11) Piccioli A, Lensing AW, Prins MH, Falanga A, Scannapieco GL, Ieran M, et al. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004; 2(6): 884-9.
(12) Di Nisio M, Otten HM, Piccioli A, Lensing AW, Prandoni P, Büller HR, et al. Decision analysis for cancer screening in idiopathic venous thromboembolism. J Thromb Haemost 2005; 3(11): 2391-6.
(13) Fennerty T. Screening for cancer in venous thromboembolic disease. BMJ 2001; 323(7315): 704-5.
(14) Van Doormaal FF, Terpstra W, Van Der Griend R, Prins MH, Nijziel MR, Van De Ree MA, et al. Is extensive screening for cancer in idiopathic venous thromboembolism warranted? J Thromb Haemost 2011; 9(1): 79-84.
(15) Trujillo-Santos J, Prandoni P, Rivron-Guillot K, Román P, Sánchez R, Tiberio G, et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost 2008; 6(2): 251-5.
(16) Bauer KA, Leung LLK, Landaw SA. Hypercoagulable disorders associated with malignancy. En: Waltham, MA, ed. UpToDate, 2011. Disponible en: http://www.uptodate.com/contents/hypercoagulable-disorders-associated-with-malignancy. Consulta: 2 noviembre 2011.
(2) Levine M. Treatment of thrombotic disorders in cancer patients. Haemostasis 1997; 27(Suppl 1): 38-43.
(3) Murchison JT, Wylie L, Stockton DL. Excess risk of cancer in patients with primary venous thromboembolism: a national, population-based cohort study. Br J Cancer 2004; 91(1): 92-5.
(4) Prandoni P, Piccioli A. Thrombosis as a harbinger of cancer. Curr Opin Hematol 2006, 13(5): 362-5.
(5) White RH, Chew HK, Zhou H, Parikh-Patel A, Harris D, Harvey D, et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med 2005; 165(15): 1782-7.
(6) Iodice S, Gandini S, Löhr M, Lowenfels AB, Maisonneuve P. Venous thromboembolic events and organ-specific occult cancers: a review and meta-analysis. J Thromb Haemost 2008; 6(5): 781-8.
(7) Sørensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998; 338(17): 1169-73.
(8) Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancer associated venous thromboembolism. N Engl J Med 2000; 343(25): 1846-50.
(9) Piccioli A, Prandoni P. Screening for occult cancer in patients with idiopathic venous thromboembolism: yes. J Thromb Haemost 2003; 1(11): 2271-2.
(10) Monreal M, Lensing AW, Prins MH, Bonet M, Fernández-Llamazares J, Muchart J, et al. Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism. J Thromb Haemost 2004; 2(6): 876-81.
(11) Piccioli A, Lensing AW, Prins MH, Falanga A, Scannapieco GL, Ieran M, et al. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004; 2(6): 884-9.
(12) Di Nisio M, Otten HM, Piccioli A, Lensing AW, Prandoni P, Büller HR, et al. Decision analysis for cancer screening in idiopathic venous thromboembolism. J Thromb Haemost 2005; 3(11): 2391-6.
(13) Fennerty T. Screening for cancer in venous thromboembolic disease. BMJ 2001; 323(7315): 704-5.
(14) Van Doormaal FF, Terpstra W, Van Der Griend R, Prins MH, Nijziel MR, Van De Ree MA, et al. Is extensive screening for cancer in idiopathic venous thromboembolism warranted? J Thromb Haemost 2011; 9(1): 79-84.
(15) Trujillo-Santos J, Prandoni P, Rivron-Guillot K, Román P, Sánchez R, Tiberio G, et al. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost 2008; 6(2): 251-5.
(16) Bauer KA, Leung LLK, Landaw SA. Hypercoagulable disorders associated with malignancy. En: Waltham, MA, ed. UpToDate, 2011. Disponible en: http://www.uptodate.com/contents/hypercoagulable-disorders-associated-with-malignancy. Consulta: 2 noviembre 2011.
Publicado
2012-07-31
Cómo citar
1.
Pérez G, Alonso J. Enfermedad tromboembólica venosa idiopática como manifestación inicial de cáncer oculto. Rev. Méd. Urug. [Internet]. 31 de julio de 2012 [citado 25 de noviembre de 2024];28(2):148-54. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/354
Sección
Trabajos de Revisión o Actualización y Puestas al día
