Thrombotic disease in cancer patients1

Abstract

Abstract Venous thromboembolism is a frequent complication in cancer patients and represents an important cause of morbidity and mortality. The risk of thrombosis depends on the specific type of malignancy and the presence of distant metastases. Furthermore, chemotherapeutic regimens and hormonal therapy as well as surgery and hospitalisation are associated with an increased rate of thromboembolism. The pathogenesis of the hypercoagulable state of malignancy involves the activation of endothelial cells and the release of tumour-associated procoagulants (tissue factor) and cytokines. Tumours can lead to uncommon sites of thrombosis by external compression of vessels and vascular invasion. Thrombosis of the hepatic vein or portal vein may be associated with myeloproliferative disorders. Due to the higher risk of thrombosis, hospitalised cancer patients should receive sufficient thromboprophylaxis. The treatment of venous thromboembolism in cancer patients is more challenging compared to the general medical population, as cancer patients have an increased risk of recurrent thrombosis, and of bleeding complications, especially in advanced cancer.