Risk of thrombosis in cancer: clinical factors and role of primary prophylaxis

Abstract

Cancer and its treatments are commonly complicated by venous thromboembolism (VTE), but there is a substantial variation in risk between individual cancer patients. The risk of VTE in cancer patients is influenced by multiple risk factors including primary site of cancer, stage, comorbidities, use of specific antineoplastic agents. Several biomarkers have been associated with subsequent VTE including D-dimer and tissue factor, although no single risk factor or biomarker accurately is predictive of VTE on its own. The risk of VTE is best predicted by a validated risk assessment score. Cancer patients at risk of VTE benefit from thromboprophylaxis, supported by evidence in the setting of hospitalization for acute medical illness and surgery, and emerging data from two large randomized trials in the outpatient setting. This chapter focuses on approaches to identifying risk of VTE and approaches to reducing this risk with appropriate thromboprophylaxis.