From the Guidelines
Trousseau sign, also known as Trousseau’s syndrome, is a condition characterized by migratory thrombophlebitis in the presence of cancer, and its clinical characteristics can include warfarin resistance, thrombocytopenia, chronic disseminated intravascular coagulation, nonbacterial thrombotic (verrucous) endocarditis, and arterial emboli, as described in the study by 1. The presence of migratory thrombophlebitis in cancer patients should increase clinical suspicion for Trousseau’s syndrome.
- The clinical characteristics of Trousseau’s syndrome can include:
- Warfarin resistance
- Thrombocytopenia
- Chronic disseminated intravascular coagulation
- Nonbacterial thrombotic (verrucous) endocarditis
- Arterial emboli
- Effective treatment of thrombosis in Trousseau’s syndrome requires the use of unfractionated or low-molecular-weight heparin or fondaparinux, as stated in the study by 1. The association of VTE with underlying malignancy was first reported by Armand Trousseau in 1865 and is supported by the results of more recent studies, including those by 1 and 1.
- Pathophysiologic explanations of the origin of VTE in cancer include known hypercoagulability, vessel wall damage, and vessel stasis from direct compression, as described in the study by 1. The occurrence of VTE has been reported to increase the likelihood of death in cancer patients by 2- to 6-fold, as stated in the study by 1, highlighting the importance of prompt diagnosis and treatment.
From the Research
Definition and Characteristics of Trousseau Sign
- Trousseau sign, also known as thrombophlebitis migrans or migratory superficial thrombophlebitis, is a paraneoplastic manifestation associated with various cancers 2, 3.
- It is characterized by recurring and migrating episodes of thrombophlebitis that can involve the upper and lower limbs, thoracic and abdominal wall, and the major blood vessels of the abdomen 2.
- The condition can lead to a detachment of a thrombus and the formation of pulmonary thromboembolism (PTE), often proving fatal for the patient 2.
Causes and Risk Factors
- The Trousseau sign of malignancy is caused by adenocarcinomas predominantly of the stomach, pancreas, and lung 2.
- Patients with cancer have a greatly increased risk of venous thrombosis, especially in the first few months after diagnosis and in the presence of distant metastases 3, 4.
- The risk of a venous thromboembolism is 4- to 7-fold higher in patients with cancer than in those without cancer 4.
Diagnosis and Treatment
- The diagnosis of Trousseau sign is based on the clinical presentation of recurring and migrating episodes of thrombophlebitis 2, 3.
- Effective prophylaxis and treatment of venous thromboembolism reduces morbidity and mortality, and improves patients' quality of life 4.
- Low molecular weight heparin is the first-line treatment for venous thromboembolism, as an effective and safe means for prophylaxis and treatment 4.
- Novel oral anticoagulants that directly inhibit factor Xa or thrombin are promising for the prophylaxis of high-risk cancer patients and in the long-term treatment of venous thromboembolism 4.
Pathophysiology
- The pathophysiology of Trousseau sign is complex and involves multiple mechanisms, including hypercoagulability associated with cancer 5.
- The syndrome probably represents a spectrum of disorders, ranging from exaggerated fluid-phased thrombosis dependent on prothrombotic agents such as tissue factor to a platelet- and endothelium-based selectin-dependent microangiopathy associated with mucin-producing carcinomas 5.
- Genetic pathways within tumor cells may trigger these thrombotic phenomena 5.