Thrombosis in cancer patients

Malignancy represents a hypercoagulable state, and thromboembolism is a commonly encountered entity in cancer patients. While incidence of thromboembolism varies amongst different types of malignancy, up to 20% of all venous thromboembolisms (VTEs) are associated with active cancer. Cancer-associated VTE is the second leading cause of mortality in cancer patients and negatively impacts both short- and long-term survivals. Unfortunately, therapeutic options remain limited and costly. Even though low molecular weight heparin agents have proven to be superior to the vitamin K antagonist warfarin in a large phase 3 trial, paucity of randomized trials in this field leaves significant uncertainty regarding optimal duration of therapy past the initial 3-6 months, treatment of recurrent thrombosis, and use of newer anticoagulants. Further research is needed to determine efficacy of novel oral anticoagulants in cancer-related VTEs and the use of these agents is not actively supported by consensus clinical guidelines at present.