Clinical Scorecard: Case Study: Trousseau Syndrome Manifesting as Multiple Cerebral Infarcts in Advanced Signet-Ring Cell Carcinoma of the Stomach: Hypercoagulability Induced by Tumor Load

At a Glance

Key Highlights

• Advanced gastric signet-ring cell carcinoma can lead to multiple cerebral infarcts.
• D-dimer levels are markedly elevated in malignancy-associated hypercoagulability.
• Anticoagulation may not prevent thrombotic events in advanced cancer.
• Effective tumor-directed therapy may reduce hypercoagulability.
• Multidisciplinary intervention is essential for optimal management.

Guideline-Based Recommendations

Diagnosis

• Consider malignancy-associated hypercoagulability in patients with advanced cancer presenting with thromboembolic events.

Management

• Initiate anticoagulation in patients with malignancy-associated thromboembolic complications.

Monitoring & Follow-up

• Regularly assess D-dimer levels to evaluate coagulation status.

Risks

• Patients with advanced malignancies are at increased risk for arterial thrombotic events despite anticoagulation.

Patient & Prescribing Data

76-year-old male with advanced gastric signet-ring cell carcinoma

Anticoagulation with enoxaparin sodium was initiated after stabilization of gastrointestinal bleeding.

Clinical Best Practices

• Monitor D-dimer levels in patients with advanced malignancies.
• Consider systemic chemotherapy as part of the management strategy for hypercoagulability.
• Implement early multidisciplinary interventions for neurological and oncologic management.

Related Resources & Content

• Malignancy-associated hypercoagulability
• Cancer-associated thrombosis
• Management of malignancy-associated hypercoagulability