Abstract
Risk prediction of chemotherapy-associated venous thromboembolism (VTE) is a compelling challenge in contemporary oncology, as VTE may result in treatment delays, impaired quality of life, and increased mortality. Current guidelines do not recommend thromboprophylaxis for primary prevention, but assessment of the patient’s individual risk of VTE prior to chemotherapy is generally advocated. In recent years, efforts have been devoted to building accurate predictive tools for VTE risk assessment in cancer patients. This review focuses on candidate biomarkers and prediction models currently under investigation, considering their advantages and disadvantages, and discussing their diagnostic performance and potential pitfalls.
Highlights
Venous thromboembolism (VTE) represents a multifactorial disease that encompasses two main clinical entities, Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE).The annual incidence rate of venous thromboembolism (VTE) varies greatly among ethnicity, ranging from 104 to 183 per100,000 person-years in Europeans, and being higher in African Americans, and lower in Asians [1].The rates of both DVT and PE increase with age [1] and, depending on the presence or not of a well defined clinical condition, it may occur either as a ‘provoked’, or as an “unprovoked’ phenomenon.Acquired and genetic risk factors often coexist, contributing to enhance VTE risk [2]
This review focuses on candidate biomarkers and prediction models for VTE risk assessment currently under investigation, considering their advantages and disadvantages, and discussing their diagnostic performance and potential pitfalls
Several parameters, associated with inflammation, whose analysis is routinely performed in laboratory practice, have been suggested to represent surrogate predictive markers of cancer-associated risk of thrombosis, and some of them have been included in risk assessment models (RAMs)
Summary
Venous thromboembolism (VTE) represents a multifactorial disease that encompasses two main clinical entities, Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). In outpatient chemotherapy candidates, the question of the benefit of primary thromboprophylaxis arises as an important issue In this regard, current guidelines recommend antithrombotic prophylaxis for patients with cancer who are hospitalized for acute medical illness, while leaving aside all the group of out-patients receiving anti-cancer therapies, for whom routine prophylaxis is not recommended, except in selected categories of patients with solid tumors at high risk of thrombosis after careful assessment and discussion with the patients themselves [15,16,17,18,19,20,21]. The feasibility of an AI approach for VTE risk prediction in chemotherapy-treated cancer patients is further described in the appropriate section
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