ABSTRACT
Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time.
Subject(s)
Anticoagulants , Neoplasms , Thrombosis , Venous Thromboembolism , Humans , Neoplasms/complications , Spain , Anticoagulants/therapeutic use , Thrombosis/etiology , Thrombosis/prevention & control , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/drug therapy , Consensus , Practice Guidelines as Topic , Heparin, Low-Molecular-Weight/therapeutic useABSTRACT
INTRODUCCIÓN: La carcinomatosis meníngea se observa en un 5% de los enfermos con cáncer. Es más habitual en procesos hematológicos que en tumores sólidos, y de estos el que con más frecuencia lo desarrolla es el carcinoma lobulillar infiltrante de mama. CASOS CLÍNICOS: Exponemos 3 casos clínicos de pacientes con carcinomatosis meníngea en los que se realizó una estrategia terapéutica diferente que evolucionó con el mismo resultado. DISCUSIÓN: Para llegar al diagnóstico son fundamentales una anamnesis y exploración clínica meticulosas. Entre las pruebas complementarias más rentables destacan: la resonancia magnética (RMN) (con una sensibilidad del 40-50%), la citología del líquido cefalorraquídeo (LCR) y el estudio del flujo del LCR mediante cisternograma con radionucleóticos. Los tratamientos están encaminados a la paliación de síntomas, mejorar la función neurológica del paciente y prolongar la supervivencia. Existen distintos manejos de esta complicación neurológica sin que ninguno de ellos haya demostrado ningún beneficio sobre los otros
INTRODUCTION: Carcinomatous meningitis is observed in 5% of the patients with cancer. This complication is more frequent in hematological processes that in solid tumors, and of theses infiltrating lobular breast cancer is the most common. Clinical cases: We present three different clinical cases of leptomeningeal metastases with different management, but obtaining the same results. DISCUSSION: A meticulous anamnesis and clinical examination is essential to arrive at a diagnosis. Of the diagnostic tests, nuclear magnetic resonance has a sensitivity of 40-50%, the cytology of the cerebrospinal fluid (CSF) is essental for a differential diagnosis (particulary infectious diseases) and finally the study of the CSF flow by radionuclide cisternogram to confirm the diagnosis. The treatments are directed at the relief of the symptoms, improving the neurological function and to prolong the survival. There are different ways to manage this neurological complication with none of them showing any benefit over the others
