Inherited thrombophilia in a patient with colorectal carcinoma

Venous thromboembolism (VTE) is a serious clinical problem. Malignancies are a common cause of VTE, and at the same time venous thrombosis plays a role in the pathogenesis of cancer. The incidence of VTE in cancer patients is 4–6 times higher than in the general population. Approximately 20% of all VTE cases occur in cancer patients. The VTE is the second most common cause of death in cancer patients. Tumour incidence is highest in the first 6 months after VTE diagnosis. Approximately 40% of VTE patients have metastasis at the time of tumour diagnosis. Cancer patients with VTE have a worse prognosis than those with malignancy alone. The pathophysiology of the hypercoagulable state and VTE is multifactorial, depending on the type of tumour, its size, localisation, growth, stage of cancer, and the condition and interaction of tissues and organ systems with malignancy. Risk factors for VTE in cancer patients include, but are not limited to, active disease and the presence of metastases [1–3]. The most important risk factors for thromboembolic disease are congenital and acquired thrombophilia (Table I). Factors such as immobility, surgical treatment, central venous catheter, or bulky disease increase the risk of thromboembolism.
We report a 48-year-old man with a history of right knee surgery followed by a deep venous thrombosis at 30 years old. The patient works in administration, is hypersthenic, and an occasional smoker. In his family history there is a presence of fatal myocardial infarction (father). The second manifestation of thromboembolism was when he was 42 years old. He was sent for examination to an angiologist for gradual pain in the right leg area, which lasted for two days with moderate intensity without physical activity. The swelling on the right side of the ankle is permanent even with compression therapy and has not changed. Varix in the leg at the back is accentuated and sensitive to palpation. Duplex ultrasonography showed varicose phlebitis in the anterior system, and a deep venous system on the forefoot and on the thigh without signs of thrombosis. The patient is D-dimer positive. Low-molecular-weight heparin (LMWH) anticoagulant treatment was initiated, with relief of symptoms. After a month, he is continuing with the regimen measures and with a compression bandage. Due to young age, we made a routine screening for malignancy – ultrasonography of abdomen, chest imaging, gastrofibroscopy and colonoscopy – all the tests were...


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