Abstract
Venous thromboembolism (vte) represents a major challenge in the management of patients with cancer. The malignant phenotype is associated with derangements in the coagulation cascade that can manifest as thrombosis, hemorrhage, or disseminated intravascular coagulation. The risk of vte is increased by a factor of approximately 6 in patients with cancer compared with non-cancer patients, and cancer patients account for approximately 20% of all newly diagnosed cases of vte. Postmortem studies have demonstrated rates of vte in patients with cancer to be as high as 50%. Despite that prevalence, vte prophylaxis is underused in hospitalized patients with cancer. Studies have demonstrated that hospitalized patients with cancer are less likely than their non-cancer counterparts to receive vte prophylaxis. Consensus guidelines address the aforementioned issues and emerging concepts in the area, including the use of risk-assessment models, biomarkers to identify patients at highest risk of vte, and use of anticoagulants as anticancer therapy. Despite those guidelines, a gulf exists between current recommendations and clinical practice; greater efforts are thus required to ensure effective implementation of strategies to reduce the incidence of vte in patients with cancer.
Highlights
Armand Trousseau first described thrombophlebitis as a presenting sign of visceral malignancy more than 150 years ago
As a consequence of these various direct and indirect mechanisms, patients with cancer have an elevated risk of venous thromboembolism
In addition to identifying patients who are at highest risk of vte, the risk score has been shown to predict favourable outcomes table i Risk factors for venous thromboembolism in patients with cancer
Summary
Armand Trousseau first described thrombophlebitis as a presenting sign of visceral malignancy more than 150 years ago. Patients with cancer can experience complications including thrombosis, bleeding, and disseminated intravascular coagulation[2]. 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[3,4,5]. Its diagnosis and management can interrupt essential cancer therapy and cause potentially serious bleeding complications[10]. Approximately 25% of cancer patients with vte require readmission because of bleeding or recurrent vte[11,12]
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