title: Cancer-associated venous thromboembolism: Burden, mechanisms, and management.
abstract: Venous thromboembolism (VTE) is a significant health problem in the general population but especially in cancer patients. In this review, we discuss the epidemiology and burden of the disease, the pathophysiology of cancer-associated VTE, and the clinical treatment options for both primary prevention and acute treatment. Overall, the development of VTE in cancer patients is related to increases in morbidity, mortality, and medical costs. However, the incidence of cancer-associated VTE varies due to patient-related factors (e.g. thrombophilia, comorbidities, performance status, history of venous diseases), tumour-related factors (e.g. cancer site, stage, grade), and treatment-related factors (e.g. surgery, chemotherapy, anti-angiogenesis treatment, hormonal and supportive treatment). Furthermore, blood count parameters (e.g. platelets and leukocytes) and biomarkers (e.g. soluble P-selectin and D-dimer) are predictive markers for the risk of VTE in cancer patients and have been used to enhance risk stratification. Evidence suggests that cancer itself is associated with a state of hypercoagulability, driven in part by the release of procoagulant factors, such as tissue factor, from malignant tissue as well as by inflammation-driven activation of endothelial cells, platelets, and leukocytes. In general, low-molecular-weight heparin (LWMH) monotherapy is the standard of care for the management of cancer-associated VTE, as vitamin K antagonists are less effective in cancer patients. Direct oral anticoagulants (DOACs) offer a potentially promising treatment option for cancer patients with VTE, but recommendations concerning the routine use of DOACs should await head-to-head studies with LMWH.
authors.affiliation: Dr. Cihan Ay, MD, Medical University of Vienna, Department of Medicine I,, Clinical Division of Haematology and Haemostaseology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 44100, Fax: +43 1 40400 40300, E-mail: cihan.ay@meduniwien.ac.at.
authors.forename: Cihan
authors.initials: C
authors.lastname: Ay
authors.forename: Ingrid
authors.initials: I
authors.lastname: Pabinger
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Cohen
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009369:Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Venous thromboembolism; cancer; epidemiology; risk factors; treatment