Abstract
Cancer-associated thrombosis is a major cause of mortality in cancer patients, the most common type being venous thromboembolism (VTE). Several risk factors for developing VTE also coexist with cancer patients, such as chemotherapy and immobilisation, contributing to the increased risk cancer patients have of developing VTE compared with non-cancer patients. Cancer cells are capable of activating the coagulation cascade and other prothrombotic properties of host cells, and many anticancer treatments themselves are being described as additional mechanisms for promoting VTE. This review will give an overview of the main thrombotic complications in cancer patients and outline the risk factors for cancer patients developing cancer-associated thrombosis, focusing on VTE as it is the most common complication observed in cancer patients. The multiple mechanisms involved in cancer-associated thrombosis, including the role of anticancer drugs, and a brief outline of the current treatment for cancer-associated thrombosis will also be discussed.
Highlights
IntroductionArmand Trousseau first reported on the relationship between thrombosis and cancer in 1865
Armand Trousseau first reported on the relationship between thrombosis and cancer in 1865.Since numerous studies have established that thrombosis is a common complication for cancer patients, contributing to the second-leading cause of mortality in cancer patients [1,2].Thrombotic complications in cancer can vary from arterial or venous thromboembolism to disseminated intravascular coagulation [3,4]
That arterial thrombosis in cancer can occur in the absence of an atherosclerotic plaque such as that observed in cardiovascular patients, where systemic hypercoagulation is induced by several secreted factors from cancer cells, such as thrombin and vascular endothelial growth factor (VEGF), thereby promoting platelet activation and coagulation [20]
Summary
Armand Trousseau first reported on the relationship between thrombosis and cancer in 1865. Thrombotic complications in cancer can vary from arterial or venous thromboembolism to disseminated intravascular coagulation [3,4]. Cancer patients are generally in a hypercoagulable or prothrombotic state, as they usually present with abnormalities in each component of Virchow’s triad, contributing to thrombosis. The specific mechanisms leading to abnormalities in Virchow’s triad in cancer patients, the effect on the host haemostatic system to promote the prothrombotic state, are not well understood and may be tumour specific as different cancer types have varying risk rates for cancer-associated thrombosis. This review will give an overview of the main thrombotic and bleeding disorders in cancer (arterial and venous thrombosis and chronic disseminated intravascular coagulation), the risk factors for developing cancer-associated thrombosis, and the Cancers 2018, 10, 380; doi:10.3390/cancers10100380 www.mdpi.com/journal/cancers. A brief outline of the current treatment of cancer-associated thrombosis will be discussed
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