Venous Thromboembolic Disease and Cardio Oncology

Abstract

Venous thromboembolism along with peripheral arterial thrombosis and cardio toxicity are some terms from the vocabulary of Oncologists that have been used increasingly in recent years. Several mechanisms have been related to the increased thrombotic complications observed in patients with cancer: 1) the expression of tissue factor by circulating tumor cells, 2) the shedding of pro coagulant micro particles by malignant cells, 3) the interaction of cancer cells with blood platelets, 4) the generation of neutrophil extracellular traps and 5) the secondary deleterious effects of anti-cancer therapies. Cancer patients with venous thrombosis experience 3fold higher rates of recurrences and 2fold major anticoagulation-associated bleeding complications than do patients without cancer. Anticoagulation treatment for venous thromboembolism differs in various groups of patients suffering from malignancies and demands a detailed knowledge of advantages and side effects of available medications. Low Molecular Weight Heparins are the first line choice, followed by vitamin K antagonists, which are widely used when treatment has to be prolonged. The new oral anticoagulants have been proven effective for venous thromboembolism (in general) and for atrial fibrillation embolic disease and thus are promising, though more studies are needed in order to investigate their detailed behavior in cancer populations. The emerging interplay between Oncologist and Cardiologists is a new provocation for the two specialties, which will probably impel them to specify a new subspecialty, the Cardio Oncology.