May Watchful Waiting Strategy Be Benefit In Patients With Coronary Thrombus Receiving BEP Chemotherapy?

Yıl 2026, Cilt: 17 Sayı: 1 , 17 - 20 , 31.03.2026

Fahri Çakan , Orhan Onalan , Tugce Colluoglu

https://doi.org/10.33706/jemcr.1713315

https://izlik.org/JA22SK28UD

Öz

The relationship between the combination of bleomycin-etoposide-cisplatin, a chemotherapeutic treatment option used in testicular carcinomas, and acute thrombotic events has been previously described. Acute coronary syndromes associated with this treatment have been frequently reported. The differences in the underlying mechanisms that lead to coronary events suggest that the treatment options may vary in these situations. The decision regarding the right treatment option for the patient sometimes emerges after a relatively long process that requires patience. In this event, which occurs without atherosclerosis and involves vasospasm and thrombus formation, a conservative approach may be beneficial.
A 42-year-old individual diagnosed with testicular cancer who did not have any cardiac risk factors was diagnosed with acute coronary syndrome. Since no atherosclerotic background is observed on coronary angiography, coronary intervention is postponed. In this case, the management of the patient will be discussed with a focus on medical treatment without any coronary intervention.

Anahtar Kelimeler

BEP regimen , thrombus , acute coronary syndrome , testicular carcinoma , Combination chemotherapy

BEP TEDAVİSİ ALAN KORONER TROMBÜSLÜ HASTALARDA YAKIN İZLEM STRATEJİSİ FAYDALI OLABİLİR Mİ?

https://izlik.org/JA22SK28UD

Öz

Testis karsinomlarında kullanılan bir kemoterapötik tedavi seçeneği olan bleomisin-etoposit-sisplatin kombinasyonunun akut trombotik olaylarla ilişkisi daha önce açıklanmıştır. Bu tedaviyle ilişkili akut koroner sendromlar sıklıkla bildirilmiştir. Koroner olaylara yol açan altta yatan mekanizmalardaki farklılıklar, bu durumlarda tedavi seçeneklerinin değişebileceğini düşündürmektedir. Hasta için doğru tedavi seçeneğine ilişkin karar bazen sabır gerektiren nispeten uzun bir sürecin ardından ortaya çıkar. Ateroskleroz olmadan gerçekleşen ve vazospazm ve trombüs oluşumunu içeren bu olayda konservatif bir yaklaşım faydalı olabilir.
42 yaşında, kardiyak risk faktörü olmayan testis kanseri tanısı konulan bir bireye akut koroner sendrom tanısı konuldu. Koroner anjiyografide aterosklerotik bir zemin gözlenmediği için koroner müdahale ertelendi. Bu durumda hastanın yönetimi, koroner müdahale olmaksızın tıbbi tedaviye odaklanılarak tartışılacaktır.

Anahtar Kelimeler

BEP rejimi , trombüs , akut koroner sendrom , testis karsinomu , Kombinasyon kemoterapisi

Kaynakça

• Centola M, Lucreziotti S, Cazzaniga S, Salerno-Uriarte D, Sponzilli C, Carugo S. A rare case of large intracoronary thrombosis in advanced breast cancer patient treated with epirubicin and cisplatin. J Cardiovasc Med (Hagerstown). 2016;17 Suppl 2:e241-e243. doi:10.2459/JCM.0000000000000444
• Blann AD, Dunmore S. Arterial and venous thrombosis in cancer patients. Cardiol Res Pract. 2011;2011:394740. doi:10.4061/2011/394740
• Oppelt P, Betbadal A, Nayak L. Approach to chemotherapy associated thrombosis. Vasc Med. 2015;20(2):153-161. doi:10.1177/1358863X14568705
• Evans WE, Yee GC, Crom WR, Pratt CB, Green AA. Clinical pharmacology of bleomycin and cisplatin. Drug Intell Clin Pharm. 1982;16(6):448-458.
• Nuver J, Smit AJ, Sleijfer DT, van Gessel AI, van Roon AM, van der Meer J, et al. Microalbuminuria, decreased fibrinolysis, and inflammation as early signs of atherosclerosis in longterm survivors of disseminated testicular cancer. Eur J Cancer. 2004;40(5):701-706. doi:10.1016/j.ejca.2003.12.012
• Shoji S, Miyakita H, Shima M, Usui Y, Nagata Y, Uchida T, et al. Acute myocardial infarction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer. Hinyokika Kiyo. 2006;52(9):723-726.
• Kawano N, Yamaguchi K, Niki T, Yamamoto T, Iwase T, Taketani Y, et al. Two cases of acute myocardial infarction during combined chemotherapy in young patients with testicular cancer. J Cardiol Cases. 2013;7(6):e176-e180. doi:10.1016/j.jccase.2013.02.009
• Ito D, Shiraishi J, Nakamura T, Maruyama N, Iwamura Y, Hashimoto S, et al. Primary percutaneous coronary intervention and intravascular ultrasound imaging for coronary thrombosis after cisplatin-based chemotherapy. Heart Vessels. 2012;27(6):634-638. doi:10.1007/s00380-011-0222-5
• Moore RA, Adel N, Riedel E, Bhutani M, Feldman DR, Tabbara NE, et al. High incidence of thromboembolic events in patients treated with cisplatin-based chemotherapy: a large retrospective analysis. J Clin Oncol. 2011;29(25):3466-3473. doi:10.1200/JCO.2011.35.5669
• Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. The New England journal of medicine. 2008;358(1):36-46. doi:10.1056/NEJMoa073149
• Tuzovic M, Herrmann J, Iliescu C, Marmagkiolis K, Ziaeian B, Yang EH. Arterial Thrombosis in Patients with Cancer. Curr Treat Options Cardiovasc Med. 2018;20(5):40. doi:10.1007/s11936-018-0635-x
• van den Belt-Dusebout AW, Nuver J, de Wit R, Gietema JA, ten Bokkel Huinink WW, Rodrigus PT, et al. Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2006;24(3):467-475. doi:10.1200/jco.2005.02.7193
• Nuver J, Smit AJ, van der Meer J, van den Berg MP, van der Graaf WT, Meinardi MT, et al. Acute chemotherapy-induced cardiovascular changes in patients with testicular cancer. J Clin Oncol. 2005;23(36):9130-9137. doi:10.1200/ JCO.2005.01.4092
• Abbott JD, Curtis JP, Murad K, Kramer HM, Remetz MS, Setaro JF, et al. Spontaneous coronary artery dissection in a woman receiving 5-fluorouracil--a case report. Angiology. 2003;54(6):721-724. doi:10.1177/000331970305400613
• Rao AS, Kumar R, Narayanan GS. A rare case of cisplatin induced acute myocardial infarction in a patient receiving chemoradiation for lung cancer. Journal of cancer research and therapeutics. 2015;11(4):983-985. doi:10.4103/0973-1482.157320
• Fukuda M, Oka M, Itoh N, Sakamoto T, Mori H, Hayakawa A, et al. Vasospastic angina likely related to cisplatin-containing chemotherapy and thoracic irradiation for lung cancer. Internal medicine (Tokyo, Japan). 1999;38(5):436-438. doi:10.2169/internalmedicine.38.436
• Ghosh N, Chow CM, Korley V, Chisholm R. An unusual case of chronic coronary artery dissection: did cisplatin play a role? The Canadian journal of cardiology. 2008;24(10):795-797. doi:10.1016/s0828-282x(08)70688-3.