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Review
. 2018 Apr 7;20(5):40.
doi: 10.1007/s11936-018-0635-x.

Arterial Thrombosis in Patients with Cancer

Mirela Tuzovic  1 , Joerg Herrmann  2 , Cezar Iliescu  3 , Kostas Marmagkiolis  4 , Boback Ziaeian  1 , Eric H Yang  5
Affiliations
Review

Arterial Thrombosis in Patients with Cancer

Mirela Tuzovic et al. Curr Treat Options Cardiovasc Med. .

Abstract

Purpose of review: Cancer is a common cause of morbidity and mortality in the USA. While the association between venous thrombosis and malignancy is well established, arterial thrombosis has more recently been recognized as a serious complication of cancer and certain chemotherapeutic agents. This review aims to summarize the most recent literature regarding the incidence and risk factors for cancer-related arterial thrombosis, understand the pathophysiologic mechanisms of thrombosis, and highlight the specific diagnostic and treatment considerations relevant to cancer patients.

Recent findings: Based on a recent study looking at the Surveillance, Epidemiology, and End Results (SEER) database, the incidence of arterial thromboembolic events (ATEs) in patients with cancer at 6 months is 4.7%; the presence of an ATE is predictive of worse outcomes. Certain drugs such as platinum-based agents, vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, and taxanes have been associated with high rates of ATEs. Increased platelet reactivity appears crucial to development of arterial thrombosis in cancer patients. Cancer patients have an increased risk of arterial thrombosis that is likely due to both a cancer-associated procoagulant state as well as the adverse effects of certain chemotherapeutic agents. Treatment of arterial thromboembolism in cancer patients typically requires a multidisciplinary approach in part due to high rates of thrombocytopenia and stent thrombosis in the setting of percutaneous interventions. More studies are needed to investigate optimal prophylaxis, surveillance strategies, and treatments of cancer-related arterial thromboembolic disease.

Keywords: Arterial thrombosis; Cancer; Chemotherapy.

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Conflict of interest statement

Conflict of Interest

Mirela Tuzovic, Cezar Iliescu, Kostas Marmagkiolis, Boback Ziaeian, and Eric H. Yang each declare no potential conflicts of interest.

Joerg Herrmann was a participant in the 2014 Ponatinib in CML Cardio-Oncology Advisory Board meeting organized by ARIAD Pharmaceuticals and the 2015 Advisory Board meeting of the Institute for Cardio-Oncology sponsored by Bristol-Myers Squibb.

Figures

Fig. 1.
Fig. 1.
*Cumulative incidence of arterial thromboembolism (composite of myocardial infarction and ischemic stroke) in patients with cancer compared to matched control patients (left panel) and when stratified by cancer stage at the time of cancer diagnosis (right panel). Competing risk survival statistics were used to calculate incidence. Dashed lines are used to indicate 95% confidence intervals. Reprinted from Navi et al., J Am Coll Cardiol 2017;70(8):926–38, with permission from Elsevier.
See this image and copyright information in PMC

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