warfarin and Bronchial-Neoplasms

Activation of coagulation and of the fibrinolytic system has been identified in small cell and non-small cell cancers respectively. For the clinician this poses the diagnostic problem of a thrombosis, which is most often venous with or without pulmonary emboli, complicating the evolution of an already diagnosed cancer. The inverse is that these features may reveal an underlying neoplasm and amongst the most common of these would be bronchopulmonary cancer. Numerous laboratory studies have shown the existence of a state of hyper-coagulability, with disseminated intra-vascular coagulation, which is more or less compensated and is the more marked, the more advanced the cancer is. One should not fail to recognise that this state of hyper-coagulability may be aggravated by certain cytotoxic drugs. At the level of the tumour itself, there seems to be interactions between the cancer cells and the coagulation and fibrinolytic system: these interactions are very different according to the histological type as to whether they are small cell or non-small cell bronchopulmonary cancers.

Topics: Anticoagulants; Antineoplastic Agents; Blood Coagulation; Blood Coagulation Disorders; Bronchial Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Disseminated Intravascular Coagulation; Female; Fibrinolysis; Humans; Lung Neoplasms; Male; Middle Aged; Randomized Controlled Trials as Topic; Thromboembolism; Thrombosis; Warfarin

The object of this study was to see if the addition of anticoagulants to a regimen of cytotoxic drugs would improve the prognosis in patients with small cell carcinoma of the bronchus. Twenty-four patients were randomly allocated to receive chemotherapy or chemotherapy plus anticoagulants. The median survival in the group receiving the anticoagulants was not improved.

Topics: Antineoplastic Agents; Bronchial Neoplasms; Carcinoma; Clinical Trials as Topic; Drug Therapy, Combination; Female; Heparin; Humans; Male; Neoplasm Metastasis; Prognosis; Random Allocation; Warfarin

Hemostatic physiology involves a complex interlinking of blood and endothelial factors. Its pharmacological manipulation invariably impacts at multiple molecular sites. Herein is reported an unusual case of coexistent warfarin-induced skin necrosis and heparin-induced thrombocytopenia following mitral valve replacement for thromboembolic phenomena associated with marantic endocarditis and bronchial adenocarcinoma. Thrombophilia in the face of endocarditis should be treated with a suspicion of underlying cancer.

Topics: Adenocarcinoma; Anticoagulants; Bronchial Neoplasms; Endocarditis; Fatal Outcome; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Heparin; Humans; Intracranial Embolism; Male; Middle Aged; Mitral Valve; Necrosis; Postoperative Complications; Skin; Thrombocytopenia; Warfarin