Cancer and Venous Thromboembolic Disease: From Molecular Mechanisms to Clinical Management

Abstract

bleeding, and disseminated intravascular coagulation 2 . Prevention and management of those complications in cancer patients can significantly affect patient treatment, prognosis, and quality of life.Venous thromboembolism (vte), which includes deep venous thrombosis (dvt) and pulmonary embolism, might precede or coincide with a diagnosis of cancer. In this patient group, vte can potentially complicate surgery, hospitalization, or systemic chemotherapy 3-5 . Risk for vte is increased by a factor of approximately 6 in patients with cancer compared with non-cancer patients, and patients with cancer account for 20% of all newly diagnosed cases of vte 6 . Postmortem studies suggest that the incidence of vte in cancer patients might be as high as 50%, in keeping with the finding that, after cancer itself, vte represents the second leading cause of death in hospitalized patients with cancer 7-9 .Venous thromboembolism is associated with high morbidity, mortality, and economic burden. Its diagnosis and management can interrupt essential cancer therapy and cause potentially serious bleeding complications 10 . Moreover, approximately 25% of cancer patients with vte require readmission because of bleeding or recurrent vte 11,12 . MECHANISMS UNDERLYING THE CANCER-ASSOCIATED PROTHROMBOTIC PHENOTYPEDirect and indirect mechanisms contribute to the pathogenesis of cancer-associated vte 13-15 (Figure 1

CHADS2 scores as a predictor of ischemic stroke after radical prostatectomy

“…An association between cancer and thrombosis has been reported . Moreover, substantial experimental data suggest that the coagulation system is implicated in multiple cancer pathways, including tumor proliferation, angiogenesis, apoptosis, and metastasis .…”

Venous Thromboembolism in Cancer Patients: A Call for More Awareness

“…Shea-Budgell, Donnellan, and colleagues in the last issue of Current Oncology, venous thromboembolism (vte) is a frequent clinical problem in cancer patients 1,2 . Thromboembolism is the 2nd leading cause of death among cancer patients and dramatically worsens cancer prognosis 3,4 .…”

“…In their narrative review, Dr. Donnellan and colleagues summarized the rationale and key recommendations in the updated version of the American Society of Clinical Oncology's clinical practice guideline, enabling clinical application of the guideline in everyday practice 1 . As emphasized in the review, cancer-specific data are available for some clinical indications (for example, pharmacologic thromboprophylaxis after cancer-related major abdominal surgery), but not for others (for example, pharmacologic thromboprophylaxis in hospitalized medically ill patients).…”

Administration of low molecular weight heparins for prolonging the survival of patients with cancer

“…Not only is venous thromboembolism (VTE) very often seen among cancer patients, but also these patients are more likely to have recurrent venous thrombosis: a three-fold higher risk for recurrent VTE compared to patients without malignancy [1][2][3][4]. Although VTE represents one of the most common causes of mortality and morbidity in cancer patients, it is unclear whether this increased mortality of cancer patients with thromboembolism is directly linked to such fatal events as pulmonary embolism.…”

“…Heparins, low molecular weight heparins (LMWHs) in particular, are regarded the first-line therapy for VTE in cancer patients, and these pharmaceutical agents are increasingly used for this purpose [1,4,[13][14][15]. The LMWHs are produced from unfractionated heparin by either chemical or enzymatic depolymerisation, with a mean molecular mass of a final product of about 5000 Da.…”