The consequent formation of a fibrin matrix appears to promote tumor growth by favoring neoangiogenesis and shielding tumor cells against attack from immunocompetent cells . Thrombin also works as a potent promoter of cancer growth and spread via an increase in tumor cell adhesion . Some biomarkers have been specifically investigated for their capacity to predict TED during the course of cancer disease. Associations between
elevated levels and future TED have been found for D-Dimer, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT), plasminogen activator inhibitor type selleckchem 1 (PAI-1), clotting see more factor VIII (FVIII) and soluble P-selectin . These markers, not sufficiently validated in patients undergoing different intraoperative anaesthetic regimens, reflect different steps of the coagulation cascade (Figure 1). In particular, F1 + 2 is released when activated factor X cleaves prothrombin into active thrombin and the fragment formation is a key event in the coagulation cascade. The formation
of TAT complexes represents an indirect measure for the activation of the coagulatory system, because is the first Selleck GDC-941 amount of thrombin that binds to antithrombin (AT). Elevated FVIII levels are a well-established risk factor for first manifestation and for recurrence of TED. PAI-1 is a potent inhibitor of the fibrinolytic system while d-dimer is a stable end product of fibrin degradation and is elevated by enhanced fibrin formation and fibrinolysis [10-12]. P-selectin, a member of cell adhesion molecules, is released from the α-granules of activated platelets and from Weibel-Palade bodies of endothelial cells.
P-selectin plays a crucial role in thrombogenesis and induces a prothrombotic state by the adhesion of platelets and leukocytes to cancer cells. Levels of soluble P-selectin are elevated in patients with acute TED . Figure 1 Coagulation cascade. The solid lines indicate a activating function, while the dashed lines a inhibitory action. Surgical tissue trauma also leads to an increased risk of TED  even though the incidence of TED is closely related to the organ involved. The tumor sites most at risk of developing TED seem to be the pancreas, brain, and stomach . In patients with advanced prostate cancers, the incidence of TED is controversial, ranging from 0.5% to 40% in the first month after surgery [3,15-17]. The Branched chain aminotransferase increased risk of TED in prostate cancer patients undergoing radical prostatectomy recommends administering a pharmacologic anti-thrombotic prophylaxis [18-22], though the latter may cause an increase in intra-operative bleeding [23,24] . To date, factors influencing the risk of perioperative thrombosis in patients undergoing prostate cancer surgery have not been identified yet. At present, we do not know whether, in addition to the risk factors already known, the use of different techniques of anesthesia may increase the risk of thrombosis in cancer patients undergoing surgery.