Cancer and thrombosis: from molecular mechanisms to clinical presentations

Abstract

Summary. Although the bidirectional association between cancer and venous thromboembolism (VTE) has been known for almost two centuries, recent advances in our understanding of the clinical, laboratory, and epidemiologic aspects of this association have created a renewed interest in this topic. This review consists of two parts. The first part discusses the occurrence, determinants and significance of VTE in those with cancer, as well as the risk of developing and the possible need to detect cancer in those presenting with VTE. The second part reviews the role of hemostatic constituents (coagulation and fibrinolytic proteins and platelets) in promoting growth and progression of cancer, as well as the effects and possible mechanisms of the low molecular weight heparins (LMWH) in this process.

Oncogenes and the coagulation system – forces that modulate dormant and aggressive states in cancer

“…Evidence to this effect includes the role of clotting factors and platelets in such fundamental processes in cancer as cellular growth, angiogenesis, metastasis, inflammation, therapeutic responsiveness and vascular comorbidities, as extensively reviewed in the recent literature [6,7,20,21,25,[84][85][86][87][88][89][90][91]. Notably, pharmacological and genetic strategies targeting TF, FVIIa, thrombin, platelets and other coagulation mechanisms led to anti-tumor and anti-metastatic effects [61,[92][93][94][95][96], which are often comparable to other 'main stream' targeted agents [87,93].…”

Differential effects of anticoagulants on tumor development of mouse cancer cell lines B16, K1735 and CT26 in lung

“…The association between cancer and venous thromboembolic events is well recognized [1,2]. Cancer cells can produce activators of the coagulation cascade and thus potential beneficial effects of anticoagulants are investigated for prevention or treatment of cancer [3,4].…”

Providing accurate information to patients who develop deep vein thrombosis

“…23 Even if the therapeutic range for anti coagulant medications is satisfied, conditions such as cancer and antiphospholipid syndrome can lead to clots, because thrombosis is initiated in these cases by mechanisms other than those that affect the coagulation system, such as activated platelets and vascular endothelium. 24,25 In summary, although thrombosis is rare in those who are receiving adequate doses of warfarin or heparin, it is not impossible. Select individuals may therefore need investigations for a predisposing cause such as malignancy.…”