Mesane kanserli hastada ciddi akut miyokard enfarktüsü ve periferik toromboz

Yıl 2017, Cilt: 1 Sayı: 3, 59 - 61, 18.12.2017

Ahmet Seyfeddin Gürbüz , Alev Kılıçgedik Yakup Alsancak , Süleyman Cagan Efe , Semi Öztürk , Mehmet Akif Düzenli Cevat Kırma

https://doi.org/10.28982/josam.344656

Öz

Kansere bağlı tromboz, hastaların yaşamlarını önemli ölçüde etkiler. Kansere bağlı trombozun venöz olayları, derin ven trombozu (DVT) ve pulmoner embolinin (PE) yanı sıra visseral veya splanknik ven trombozunu içeren venöz tromboembolizmdir (VTE). Arteriyel olaylar ise inme ve miyokard enfarktüsünü içerir. Bu hastada, miyokard enfarktüsü ve kardiyojenik şok, periferik trombozla birlikte yaygın koroner tromboz ile ilişkilidir.  Hastada kardiyovasküler risk faktörlerinden sigara ve hipertansiyon, ayrıca öyküsünde mesane karsinomu nedeniyle cerrahi mevcuttu. Muhtemelen kanserin kendisi ve cerrahisi tarafından kolaylaştırılan ciddi hiperkoagülan durum çok damar koroner ve periferal yoğun trombüs yüküne neden oldu. Revaskülarizasyon ve trombektomi ameliyatı yapılmadan önce intrakoroner 10 mcg / kg tirofiban bolus ve 15 mg doku plasminojen aktivatörü (tPA) sırasıyla uygulandı. Tam revaskülarizasyon elde edildi.

Anahtar Kelimeler

mesane kanser, miyokard enfarktüsü, periferik iskemi, tromboz

Severe acute myocardial infarction and peripheral thrombosis in patient with bladder cancer

Öz

Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA) were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

Anahtar Kelimeler

bladder cancer, myocardial infarction, peripheral ischemia

Kaynakça

• 1- Lee AY. Thrombosis and cancer: the role of screening for occult cancer and recognizing the underlying biological mechanisms. Hematology Am Soc Hematol Educ Program. 2006;438:43.
• 2- Khorana AA. Cancer and thrombosis: implications of published guidelines for clinical practice. Ann Oncol. 2009;1619:30.
• 3- Khorana AA. Cancer and coagulation. Am J Hematol. 2012;87:82-7
• 4- Sousou T, Khorana AA. New insights into cancer-associated thrombosis. Arterioscler Thromb Vasc Biol. 2009;29:316-20.
• 5- Vasu S, Hundley WG. Understanding cardiovascular injury after treatment for cancer: an overview of current uses and future directions of cardiovascular magnetic resonance.J Cardiovasc Magn Reson. 2013;15:66
• 6- Noble S, Pasi J. Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer. 2010;102:2-9.
• 7- De la Fouchardière C, Flechon A, Droz JP. Coagulopathy in prostate cancer.Neth J Med. 2011; 61:347-54.
• 8- Nalluri SR, Chu D, Keresztes R et al. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA. 2008; 300:2277-85. 9- Horsted F, West J, Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med.2012; 9:e1001275.
• 10- Levitan N, Dowlati A, Remick SC. Rates of initial and recurrent thromboembolic disease among patients with malignancyvs those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore) 1999; 78:285-91. 11- Chew HK, Wun T, Harvey D et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006; 166:458-64.
• 12- Sandhu R, Pan CX, Wun T et al. The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer. Cancer. 2010; 116:2596-603.
• 13- Villemur B, Payraud E, Seetha V et al. Arterial bypass iterative thrombosis and cancer: three cases. J Mal Vasc. 2014; 39:14-7. 14- Kanemaru K, Nishiyama Y, Yoshioka H et al. Instent thrombosis after carotid artery stenting despite sufficient antiplatelet therapy in a bladder cancer patient. J Stroke Cerebrovasc Dis. 2013; 22:1196-200.