Cancer-associated venous thromboembolism: risk assessment, prevention, and treatment
The association between cancer and the development of venous thromboembolism is well documented. Cancer-related venous thromboembolism is associated with worsened short-term as well as long-term survival — it also affects the quality of life of the patient and may delay ongoing treatment. Interaction of cancer cells as well as effects of chemotherapy can lead to a systematic activation of coagulation system. Consequently, venous thromboembolism in cancer patients has been associated with several tumor-, treatment- and patient-related risk factors. Several studies focused on possibilities to predict the risk of venous thromboembolism in cancer patients. However, patient selection for prophylactic antithrombotic treatment remains a matter of controversy. In contrast, treatment of cancer-associated venous thromboembolism using low molecular weight heparin is well established. The role of the novel anticoagulants — new oral factor Xa and thrombin inhibitors in the treatment of cancer patients with venous thromboembolism remains to be determined. In this review, recently published studies and guidelines regarding risk assessment, prevention, and treatment of cancer-associated venous thromboembolism are summarized.