Cancer and coagulation

Abstract

Thromboembolism, including both venous and arterial events, occurs commonly amongst patients with cancer. The occurrence of thromboembolism has significant consequences for cancer patients, including direct and indirect associations with mortality, morbidity, requirement for long-term anticoagulant therapy and consumption of healthcare resources. Recent studies have resulted in a better understanding of clinical risk factors and biomarkers of cancer-associated thrombosis, and a risk assessment model incorporating both has now been validated in multiple settings. Thromboprophylaxis with either unfractionated heparin or low-molecular-weight heparins (LMWHs) has been shown to be safe and effective in high-risk settings such as hospitalization for medical illness and the postsurgical period. Emerging new data from randomized studies have focused on outpatient prophylaxis, suggesting potential benefits in this setting as well. Treatment of cancer-associated thrombosis requires long-term anticoagulation with LMWH. Results from ongoing and planned trials of novel anticoagulants in the cancer setting are awaited.

Figure 1. Thromboprophylaxis in the Outpatient Setting

Rates of VTE (%) in four recent RCTs of LMWH prophylaxis in patients with solid tumors are shown. These included PROTECHT (P= 0.02) and SAVE-ONCO (both included various locally advanced or metastatic solid tumors) and CONKO-004 (P <0.01) and FRAGEM (P = 0.019) both included advanced pancreatic cancers only).