PO-57 - Problems of diagnostics of rare localizations thrombosis in cancer patients

Abstract

Thrombosis of rare localizations: hepatic vein thrombosis, splenic, mesenteric, ovarian veins, brain, portal vein are life-threatening disorders, which often goes unrecognized. The most frequently atypical localizations develop thrombosis in patients with inherited defects of hemostasis - genetic thrombophilia. Rare localizations of thrombosis often accompanied acquired abnormalities of hemostasis, which include antiphospholipid syndrome, hypercoagulation in oncology. The detection of thrombosis rare localizations required screening for genetic forms of thrombophilia and antiphospholipid syndrome and timely appointment of anticoagulant therapy. Since 2006 we have observed 1214 patients with gynecological cancer. In 10 cases we have observed unusual localization thrombosis: Hepatic vein thrombosis (Budd-Chiari syndrome) - in 1 case, Splenic vein thrombosis - 2 cases, renal vein thrombosis - 1 case, thrombosis of retinal artery and vein - 3 cases, Cerebral venous thrombosis - 1 case, mesenteric thrombosis - 2 cases, one of them has lead to death in early postsurgery period. APA circulation has been found in all cases: antibodies to B2Gp1a, antibodies to Annexin V and antibodies to prothrombin. The factor FV Leiden homozygous mutation was found 9 patients, except 1 patient with retinal vein thrombosis, the homozygous MTHFR mutation has been found in 9 patients, heterozygous in 2; prothrombin mutation in 9; PAI-1 polymorphism in all 10 cases, platelets glycoproteins polymorphism in 7 cases. In 56 y.o. patient with ovarian cancer despite of anticoagulation therapy with LMWH has been found mesenteric thrombosis in 2 day after surgery. In addition to the above mentioned mutations it was found ADAMTS13 gene mutation. Presence of multigene forms of genetic thrombophilia and APA-circulation increase risk of rare localizations thrombotic complications in cancer patients, therefore such patients required in intensive permanent preventive maintenance with use of LMWH.