Antikoagulation als onkologisches Therapieprinzip

Zusammenfassung

Die Assoziation von Tumorerkrankungen mit thromboembolischen Komplikationen ist seit mehr als hundert Jahren bekannt. Während die thrombophile Diathese von Tumorpatienten und die paraneoplastische Thrombogenese pathophysiologisch teilweise geklärt sind, ergeben neuere Untersuchungen Hinweise dafür, dass Mediatoren der plasmatischen Hämostase Tumorwachstum, Angiogenese und Metastasierung beeinflussen. Die Grundlage einer antithrombotischen Prophylaxe und Therapie bei Tumorpatienten leitet sich deshalb nicht nur aus der bekannten Thromboseneigung der Patienten ab, sondern auch aus der potenziell antineoplastischen bzw. antimetastatischen Wirkung einer pharmakologischen Gerinnungshemmung. Erfolgversprechende Ergebnisse klinischer Studien lassen darauf schließen, dass das Überleben ausgewählter Tumorpatienten durch prophylaktische bzw. therapeutische Antikoagulation verbessert werden kann.

Summary

The association of cancer with thromboembolic events has been established for more than hundred years. While the thrombophilic diathesis of tumor patients and the neoplastic thrombogenesis have been elucidated pathophysiologically, at least in part, there is growing experimental and clinical evidence that factors of plasmic hemostasis promote tumor growth, angiogenesis, and metastasis. Thus, the rationale for antithrombotic prophylaxis and therapy of tumor patients might not only be based on the prevention of thromboembolic complications but also on the potentially antineoplastic and antimetastatic effects of pharmacological anticoagulation. Encouraging results of clinical studies indicate that prophylactic and therapeutic anticoagulation might improve the survival of selected patients with cancer.

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