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.

Keywords: cancer; low-molecular-weight heparin; management; thrombosis.

Figure 1

Factors involved in cancer-associated thrombosis. Abbreviations: CP, Cancer procoagulant; TF, Tissue factor; TNF-α, Tumor necrosis factor-α; IL-1β, Interleukin-1β; VEGF, Vascular endothelial growth factor; FVIII, Factor VIII; vWF, Von Willebrand factor; ADP, Adenosine diphosphat. Source: Karimi M, Cohan N. Cancer-Associated Thrombosis. The Open Cardiovascular Medicine Journal 2010;4:78–82. doi:10.2174/1874192401004020078.