Cancer-associated thrombosis: the when, how and why

Abstract

Cancer-associated thrombosis (CAT) is a condition in which relevance has been increasingly recognised both for physicians that deal with venous thromboembolism (VTE) and for oncologists. It is currently estimated that the annual incidence of VTE in patients with cancer is 0.5% compared to 0.1% in the general population. Active cancer accounts for 20% of the overall incidence of VTE. Of note, VTE is the second most prevalent cause of death in cancer, second only to the progression of the disease, and cancer is the most prevalent cause of deaths in VTE patients. Nevertheless, CAT presents several peculiarities that distinguish it from other VTE, both in pathophysiology mechanisms, risk factors and especially in treatment, which need to be considered. CAT data will be reviewed in this review.

A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

“…1,2 The incidence of VTE is relatively low in urologic cancer compared with other cancer types. [3][4][5] However, the adequate management of cancer-associated VTE is important to prevent patient mortality. Anticoagulation is the mainstay of VTE treatment in which anticoagulants are ap-propriately decided by the clinicians to prevent bleeding events in patients.…”

Thrombotic disorders (part 2)

“…major surgery, immobilisation, vascular obstruction by tumour masses or indwelling venous catheters). [21] VTE rates are particularly high in certain types of cancer (such as haematological neoplasms, and tumours of the stomach, pancreas, brain, lung and breast), [21,22] in advanced-stage disease and when therapeutic agents with increased thrombogenic potential are used, such as platinum-based chemotherapy agents, immunomodulatory drugs (e.g. thalidamide, tamoxifen) and haemopoietic-stimulating agents (e.g.…”

“…erythropoietin). [21,22] Despite the increased risk of VTE in association with cancer, routine primary prophylaxis among ambulatory individuals with a malignancy is not advocated, as the rate of bleeding complications is also elevated with LMWH-based VTE prophylaxis. [21,22] However, thromboprophylaxis is recommended for hospital inpatients, particularly following major surgery, such as abdomenopelvic surgery, which necessitates prophylaxis with LMWH for 30 days.…”

“…[21,22] Despite the increased risk of VTE in association with cancer, routine primary prophylaxis among ambulatory individuals with a malignancy is not advocated, as the rate of bleeding complications is also elevated with LMWH-based VTE prophylaxis. [21,22] However, thromboprophylaxis is recommended for hospital inpatients, particularly following major surgery, such as abdomenopelvic surgery, which necessitates prophylaxis with LMWH for 30 days. [21] Among patients with confirmed thrombosis, therapeutic doses of LMWH have shown superior efficacy compared with oral vitamin K antagonists, possibly due to difficulties in achieving predictable anticoagulation in patients with cancer owing to numerous drug-drug interactions, poor diet/vomiting (which can affect vitamin K bio-availability) or associated liver/renal impairment.…”

“…[21,22] However, thromboprophylaxis is recommended for hospital inpatients, particularly following major surgery, such as abdomenopelvic surgery, which necessitates prophylaxis with LMWH for 30 days. [21] Among patients with confirmed thrombosis, therapeutic doses of LMWH have shown superior efficacy compared with oral vitamin K antagonists, possibly due to difficulties in achieving predictable anticoagulation in patients with cancer owing to numerous drug-drug interactions, poor diet/vomiting (which can affect vitamin K bio-availability) or associated liver/renal impairment. [21] Early indications suggest that the DOACs, rivaroxaban, apixaban and edoxaban (of which only rivaroxaban is currently available in SA), may be acceptable alternatives for the management of VTE, but caution is warranted if potent inducers or inhibitors of CYP450 are used concomitantly.…”