Cancer-Associated Thrombosis: An Overview

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Cancer and its treatments are well-known risk factors for venous thromboembolism (VTE). VTE is the second most frequent cause of death in patients with cancer and can adversely effect their quality of life. Anticoagulants and thromboprophylaxis can protect patients from this adverse effect. Goals for treatment of VTE in patients with cancer are to reduce mortality and morbidity and improve quality of life.

Preferred initial therapy for VTE in patients with cancer is low-molecular-weight heparin (LMWH)-based therapy over warfarin-based therapy or vitamin K antagonists (VKAs), according to guidelines from the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), the American College of Chest Physicians (ACCP), and the National Cancer Comprehensive Network (NCCN). Initial treatment should be extended for 3 to 6 months. Continuation of therapy beyond that should be based on the risk for recurrent thrombosis versus the risk of major bleeding for each individual patient.

These authors conclude that subcutaneous LMWH has replaced UFH and VKAs as the first-line therapy for VTE in patients with cancer. The treatment duration is 3 to 6 months, and in the presence of active neoplastic disease or very high risk of recurrence, it may be continued indefinitely. However, survival benefits should be weighed against the risks, costs, and inconvenience of chemopreventive anticoagulation. Novel oral anticoagulants (NOACs) are an emerging development in the treatment and prevention of VTE. NOACs target specific clotting cascade factors, and they have characteristics that make treatment with these agents more attractive for both clinicians and patients. 

Clinical Medicine Insights: Oncology
Clinical Medicine Insights: Oncology

ABSTRACT: Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. In addition to VTE, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, and is possibly related to genetic predisposition. Several risk factors for developing venous thrombosis usually coexist in cancer patients including surgery, hospital admissions and immobilization, the presence of an indwelling central catheter, chemotherapy, use of erythropoiesis-stimulating agents (ESAs) and new molecular-targeted therapies such as antiangiogenic agents. Effective prophylaxis and treatment of VTE reduced morbidity and mortality, and improved quality of life. Low-molecular-weight heparin (LMWH) is preferred as an effective and safe means for prophylaxis and treatment of VTE. It has largely replaced unfractionated heparin (UFH) and vitamin K antagonists (VKAs). Recently, the development of novel oral anticoagulants (NOACs) that directly inhibit factor Xa or thrombin is a milestone achievement in the prevention and treatment of VTE. This review will focus on the epidemiology and pathophysiology of cancer-associated thrombosis, risk factors, and new predictive biomarkers for VTE as well as discuss novel prevention and management regimens of VTE in cancer according to published guidelines.

KEYWORDS: cancer, thrombosis, management, low-molecular-weight heparin

CITATION: Elyamany et al. Cancer-Associated Thrombosis: An Overview. Clinical Medicine Insights: Oncology 2014:8 129–137 doi: 10.4137/CMO.S18991.

RECEIVED: July 27, 2014. RESUBMITTED: September 24, 2014. ACCEPTED FOR PUBLICATION: September 27, 2014.

ACADEMIC EDITOR: William CS Cho, Editor in Chief

TYPE: Review

FUNDING: Authors disclose no funding sources.

COMPETING INTERESTS: Authors disclose no potential conflicts of interest.

COPYRIGHT: © the authors, publisher and licensee Libertas Academica Limited. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.


Paper subject to independent expert blind peer review by minimum of two reviewers. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).  

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