title: Assessing the risk and prognosis of thrombotic complications in cancer patients.
abstract: BACKGROUND
  Cancer is characterized by the development of a prothrombotic state. Approximately 15% to 20% and 1.5% to 3.1% of cancer patients develop venous and arterial thrombosis, respectively, whereas 18% to 20% of idiopathic venous events are caused by an occult neoplasia. The highest risk is observed in hematologic, gastrointestinal, and lung malignancies, as well as in patients with active disease, especially in the first 3 months after cancer diagnosis. Hospitalization, surgical interventions, and implanted venous devices increase the thrombotic risk. Patients with metastatic disease, febrile neutropenia, infections, and severe comorbidities experience more frequently a thrombotic event. A contemporary prechemotherapy predictive model incorporates both clinical and biologic parameters, such as the primary cancer site, platelet count, white blood cell count, hemoglobin, use of erythropoietic agents, and body mass index. Several studies aim to clarify the prognostic value of tissue factor, P-selectin, thrombin generation, microparticles, and D-dimers.
  
  
  OBJECTIVE
  To summarize current views on epidemiology, risk factors, and predictive variables, discussing the future perspectives and existing limitations in clinical practice.
  
  
  METHODS
  Review of published literature, including review papers, epidemiologic studies, and clinical trials, in online medical databases.
  
  
  CONCLUSIONS
  The thrombogenic properties of tumor cells affect the prognosis and quality of life for the cancer population. Despite the improved awareness and prompt use of thromboprophylaxis, recent studies reported increased rates of thrombotic events, whereas the annual risks for thrombosis recurrence and bleeding are 21% and 12%, respectively. The clinical use of risk factors and prognostic parameters could allow for patient risk stratification and individualization of anticoagulant treatment.
authors.affiliation: Department of Hematology, Lincoln County Hospital, United Kingdom. kyriazivasiliki@yahoo.com
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Kyriazi
authors.forename: Elisavet
authors.initials: E
authors.lastname: Theodoulou
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D014408:Biomarkers, Tumor