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Thrombosis and cancer

Nature Reviews Clinical Oncology volume 9, pages 437–449 (2012)Cite this article

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Abstract

Venous thromboembolism (VTE) is a potentially life-threatening condition that can be associated with significant morbidity. Thrombosis and cancer are linked by numerous pathophysiological mechanisms; the frequency of VTE and the recurrence rate are increased in the cancer population in comparison with other patient groups. VTE is the second most common cause of death in patients with cancer, but can also be the initial presenting complaint in patients with an occult malignancy. Risk factors for cancer-related VTE include tumour type, surgery, chemotherapy and the use of central venous catheters; predictors of VTE for individuals are only now beginning to emerge. Patients with cancer who develop symptomatic VTE during chemotherapy are at a greater risk of early mortality than those without VTE. The apparent impact of VTE on early mortality in patients with cancer raises the question of whether anticoagulation might improve long-term survival in this population, by direct tumour biology-modifying mechanisms. There are widely published guidelines that highlight the benefits of effective VTE strategies in patients with cancer. In partnership with the patient and their carers, the clinical team can improve patient outcomes with optimal risk assessment and concordance with national and international guidelines in the prophylaxis and treatment of VTE.

Key Points

  • Venous thromboembolism (VTE) in patients with cancer is an important clinical problem

  • Patients should be informed about VTE risk and/or treatment and should be involved in their care, including monitoring for bleeding

  • VTE risk assessment and, if appropriate, thromboprophylaxis of patients with cancer are key to individualized care

  • Tissue factor (TF) is a key mediator of clotting, inflammation, tumour progression and angiogenesis; the association between elevated TF and subsequent VTE is under investigation

  • Further research is needed in the cancer setting with the new oral anticoagulants

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Figure 1: Genetic changes upregulate molecules responsible for neoplastic transformation and tumour procoagulant activity.
Figure 2: Flow diagram of venous thromboembolism risk assessment.
Figure 3: Anticoagulant effect on mortality in patients receiving chemotherapy.

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Authors and Affiliations

  1. Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Annie Young & Christopher Poole

  2. Department of Haematology, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Oliver Chapman

  3. Aylesford Unit, South Warwickshire NHS Foundation Trust, Warwick, CV34 5BW, UK

    Carole Connor & Peter Rose

  4. University College London, Gower Street, London, WC1E 6BT, UK

    Ajay K. Kakkar

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  1. Annie Young
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  2. Oliver Chapman
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  3. Carole Connor
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  4. Christopher Poole
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  5. Peter Rose
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  6. Ajay K. Kakkar
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Contributions

A. Young researched the data for the article. A. Young, O. Chapman, P. Rose and A. K. Kakkar made a substantial contribution to the discussion of content, and wrote and edited the manuscript prior to submission. C. Connor and C. Poole wrote sections according to their expertise, and critiqued the full manuscript and amended accordingly.

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Correspondence to Annie Young.

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Competing interests

O. Chapman has received honoraria from Boehringer Ingelheim. P. Rose has received honoraria from Bayer Healthcare, Boehringer Ingelheim, Bristol Myers Squibb and Roche. A. K. Kakkar has received grants and honoraria from Bayer Healthcare, Boehringer Ingelheim, Eisai and Pfizer. He has acted as a consultant for, and received grants and honoraria from Sanofi Aventis and he has received honoraria from Bristol Myers Squibb and GlaxoSmithKline. The other authors declare no competing interests.

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Young, A., Chapman, O., Connor, C. et al. Thrombosis and cancer. Nat Rev Clin Oncol 9, 437–449 (2012). https://doi.org/10.1038/nrclinonc.2012.106

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