The protrombotic state in patients with cancer

Abstract

Cancer is an acquired prothrombotic state with an increased risk of thrombosis. Thromboembolic complications are the second cause of death, and pulmonary thromboembolism counts for about 50% of necropsies of cancer patients. In these patients, the prothrombotic state is a subclinical condition that is detected by the presence of an increase in serum fibrinogen levels, fibrin degradation products, coagulation factors such as factor V, VII, IX, X, and thrombocytosis, among others. In the cancer prothrombotic state, the biological mechanisms modify Virchow's triad elements, and cell activity, modify proteins, and neoplastic cells produce procoagulant molecules, fibrinolytic, and proinflammatory cytokines. The Khorana predictive model, which includes the measurement of biomarkers such as D dimer and P selectin, allows stratifying clinical risk. Prevention of venous thromboembolism in patients at higher risk could improve the response to treatment and survival. Therefore, properly designed studies should clarify the effect of thromboprophylaxis in these patients.