Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

Abstract

Context.—Cancer is characterized by the development of a prothrombotic state. Approximately 15% to 20% and 1.5% to 3.1% of cancer patients develop venous and arterial thrombosis, respectively, whereas 18% to 20% of idiopathic venous events are caused by an occult neoplasia. The highest risk is observed in hematologic, gastrointestinal, and lung malignancies, as well as in patients with active disease, especially in the first 3 months after cancer diagnosis. Hospitalization, surgical interventions, and implanted venous devices increase the thrombotic risk. Patients with metastatic disease, febrile neutropenia, infections, and severe comorbidities experience more frequently a thrombotic event. A contemporary prechemotherapy predictive model incorporates both clinical and biologic parameters, such as the primary cancer site, platelet count, white blood cell count, hemoglobin, use of erythropoietic agents, and body mass index. Several studies aim to clarify the prognostic value of tissue factor, P-selectin, thrombin generation, microparticles, and D-dimers. Objectives.—To summarize current views on epidemiology, risk factors, and predictive variables, discussing the future perspectives and existing limitations in clinical practice. Data Sources.—Review of published literature, including review papers, epidemiologic studies, and clinical trials, in online medical databases. Conclusions.—The thrombogenic properties of tumor cells affect the prognosis and quality of life for the cancer population. Despite the improved awareness and prompt use of thromboprophylaxis, recent studies reported increased rates of thrombotic events, whereas the annual risks for thrombosis recurrence and bleeding are 21% and 12%, respectively. The clinical use of risk factors and prognostic parameters could allow for patient risk stratification and individualization of anticoagulant treatment.

Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

“…Since ischemic stroke and cancer share some of the same risk factors, the occurrence of both these conditions in the same individual may be secondary to dual predisposition by shared risk factors such as cigarette smoking and alcohol consumption [22,23]. Occult cancer at the time of ischemic stroke occurrence leading to a prothrombotic state is another possibility [24]. The high rate of skin cancer in stroke survivors may be related to increasing rates of melanoma seen in Asians and Hispanics, people in lower socioeconomic groups, and elderly White men, all of whom are at higher risk for ischemic stroke [25].…”

Risk Factors of Postoperative Nosocomial Pneumonia in Stage I-IIIa Lung Cancer Patients

“…however, one problem is that this treatment is subject to complications (D'journo et al, 2011). The general incidence of postoperative complications after thoracic surgery is approximately 30%, making it the most frequent and the most common causes of mortality after lung resection (Stephan et al, 2000;Kyriazi and Theodoulou, 2013). Moreover, patients undergoing lung cancer resection are at special risk for postoperative respiratory infections, with an incidence ranging from 2 to 20%.…”

Maintenance use of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) and prostate cancer risk

“…Sweden is highly developed yet relatively small country considering the number of inhabitants (~10 million) and the majority of the population is of European decent with relatively limited differences in socio-economic status, so we assume that socio-economic and ethno-geographic risk factors have a limited impact on the results. Confounding by indication may, however, be a problem, in particular for aspirin use, since aspirin use may be administered for thrombotic events related to cancer, although a 6 month duration of aspirin use before any cancer diagnosis was used to define maintenance use [23]. Unfortunately, no data on prescribed drug use before July 2005 could be collected since The Swedish Prescribed Drug Registry started from 1 July 2005.…”