Cancer-Associated Thrombosis: An Overview

Abstract

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. In addition to VTE, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, and is possibly related to genetic predisposition. Several risk factors for developing venous thrombosis usually coexist in cancer patients including surgery, hospital admissions and immobilization, the presence of an indwelling central catheter, chemotherapy, use of erythropoiesis-stimulating agents (ESAs) and new molecular-targeted therapies such as antiangiogenic agents. Effective prophylaxis and treatment of VTE reduced morbidity and mortality, and improved quality of life. Low-molecular-weight heparin (LMWH) is preferred as an effective and safe means for prophylaxis and treatment of VTE. It has largely replaced unfractionated heparin (UFH) and vitamin K antagonists (VKAs). Recently, the development of novel oral anticoagulants (NOACs) that directly inhibit factor Xa or thrombin is a milestone achievement in the prevention and treatment of VTE. This review will focus on the epidemiology and pathophysiology of cancer-associated thrombosis, risk factors, and new predictive biomarkers for VTE as well as discuss novel prevention and management regimens of VTE in cancer according to published guidelines.

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…Venous thromboembolism often occurs in the natural course of cancer disease [32]. At the same time, however, attempts of treatment, especially surgical treatment, increase the risk of this complication [4,9,10,14,15,32,33].…”

“…At the same time, however, attempts of treatment, especially surgical treatment, increase the risk of this complication [4,9,10,14,15,32,33]. Surgery affects the risk of thrombosis through multiple factors; tissue trauma due to surgical procedures, periprocedural immobilization, blood and plasma substitution, positive pressure ventilation, potential inflammation foci or intravenous catheters [14,[34][35][36][37][38][39].…”

“…In most of the above mentioned research in patients undergoing major surgery in the abdominal and pelvic area, including surgical oncology, thrombosis prophylaxis was administered up to 7-10 days after surgery, which according to current knowledge may be insufficient [4,14,32,33]. Conclusions from randomized clinical trials that relate to extended (up to 4 weeks) primary VTE postsurgical prophylaxis (ENOXACAN II -extended prophylaxis after major surgery in the abdominal and pelvis area; FAME -extended prophylaxis in extensive surgery of the abdominal and pelvis area) indicate potential benefits of such management of surgical patients at high risk of thromboembolic complications [78,79].…”

“…Cancer itself is an important risk factor for VTE not only in surgical patients, but also in those hospitalized on surgical and non-surgical wards and treated conservatively [4,9,23,28,32,33,254]. Because of the tumor, concomitant risk factors of VTE and factors relating to both patient's condition and treatment itself, most cancer patients admitted to the hospital will require thromboprophylaxis adequate to the risk [15,32,33,36,38,254].…”

“…Because of the tumor, concomitant risk factors of VTE and factors relating to both patient's condition and treatment itself, most cancer patients admitted to the hospital will require thromboprophylaxis adequate to the risk [15,32,33,36,38,254]. Despite the Venous thromboembolism prophylaxis in cancer patients lack of qualifications for surgical treatment, cancer patients receiving conservative treatment in the hospital (also in surgical wards) are also at higher risk of VTE [15,32,36,254] (Table 2).…”