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(Circulation. 2003;107:I-17.)
© 2003 American Heart Association, Inc.

Four Topics in Venous Thromboembolism

Venous Thromboembolism and Cancer: Risks and Outcomes

Agnes Y.Y. Lee, MD, FRCPC; Mark N. Levine, MD, FRCPC

From the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Correspondence to Agnes Lee, M.D., F.R.C.P.C., Hamilton Health Sciences, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada. Phone: 905-527-4322, extension 42484, Fax: 905-574-7625, E-mail: alee{at}mcmaster.ca

Abstract

Cancer and its treatments are well-recognized risk factors for venous thromboembolism (VTE). Evidence suggests that the absolute risk depends on the tumor type, the stage or extent of the cancer, and treatment with antineoplastic agents. Furthermore, age, surgery, immobilization, and other comorbid features will also influence the overall likelihood of thrombotic complications, as they do in patients without cancer. The role of hereditary thrombophilia in patients with cancer and thrombosis is still unclear, and screening for this condition in cancer patients is not indicated. The most common malignancies associated with thrombosis are those of the breast, colon, and lung, reflecting the prevalence of these malignancies in the general population. When adjusted for disease prevalence, the cancers most strongly associated with thrombotic complications are those of the pancreas, ovary, and brain. Idiopathic thrombosis can be the first manifestation of an occult malignancy. However, intensive screening for cancer in patients with VTE often does not improve survival and is not generally warranted. Independently of the timing of cancer diagnosis (before or after the VTE), the life expectancy of cancer patients with VTE is relatively short, because of both deaths from recurrent VTE and the cancer itself. Patients with cancer and acute VTE who take anticoagulants for an extended period are at increased risk of recurrent VTE and bleeding. A recent randomized trial, the Randomized Comparison of Low Molecular Weight Heparin versus Oral Anticoagulant Therapy for Long-Term Anticoagulation in Cancer Patients with Venous Thromboembolism (CLOT) study, showed that low molecular weight heparin may be a better treatment option for this group of patients. The antineoplastic effects of anticoagulants are being actively investigated with promising preliminary results.

Key Words: thrombosis • coagulation • neoplasm

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