Abstract
Acute thrombotic events can unveil occult cancer, as they are its first manifestation in about 20 to 30% of all cases. Malignancy interacts in an intricate way with the hemostatic system, promoting both thrombosis and bleeding. The main pathway involved in these reactions involves the activation of tumor-associated procoagulant factors, which eventually results in clot formation. The clinical manifestation of cancer-related thrombotic events mainly involves the venous side, and manifests in a broad spectrum of conditions, including unusual sites of venous thrombosis. The selection of patients who have a balanced risk–benefit profile for management of anticoagulation is complex, given individual patient goals and preferences, different prognosis of specific cancers, common comorbidities, potential drug–drug interactions, underweight states, and the competing risks of morbidity and mortality. Anticoagulant treatment in cancer settings is broadly debated, considering the potential application of direct oral anticoagulants in both thromboprophylaxis and secondary prevention, having demonstrated its efficacy and safety compared to conventional treatment. This review aims to provide a brief overview of the pathophysiology and management of cancer-related thrombosis, summarizing the results obtained in recent clinical trials.
Highlights
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Other common risk factors for venous thrombosis in non‐cancer populations, which may recur in this context, such as prolonged immobility after a surgical treatment, placement of central venous catheters (CVC), or prothrombotic mutations, should be a concern when assessing thrombotic risk in cancer patients. [11,17]
Tumor cells release a variety of procoagulant substances, such as tissue factor (TF), TF‐positive tumor‐derived microparticles (MPs), cancer procoagulant (CP) factor, and heparinase, resulting in a hypercoagulable state [18]
Summary
MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. When a thrombotic event occurs, the presence of active malignancy is considered a determinant of unfavorable evolution, when compared to traditional counterparts. In this setting, anticoagulation management should be prompt and aggressive. Cancer may increase the rate of bleeding events that account for higher mortality, with an incidence of 10% in solid tumors, and an even higher proportion in patients with hematologic malignancies [5]. Treatment of venous thromboembolism (VTE) in patients with cancer can be challenging, faced with serious complications including increased risk of bleeding, potential drug–drug interactions that accompany chemotherapy, underweight states, and the competing risks of morbidity and mortality
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