Cancer and venous thromboembolism: a multidisciplinary approach

In this paper, we briefly review the relation between cancer and venous thromboembolism (VTE), an association that has been recognized for more than a century. In particular we focus on VTE as predictor and prognostic factor for cancer and the antineoplastic potential of antithrombotic treatment. Cancer may cause disturbances in the haemostatic system by numerous mechanisms that can lead to an increased risk of VTE. Patients with known cancer are at increased risk of VTE; however, VTE may also be a predictor of subsequent cancer in the years afterwards. Furthermore, cancer patients with VTE are more likely to have advanced disease and a worse prognosis than cancer patients without a VTE episode. These findings may have implications for the clinical care of patients with VTE in terms of screening for cancer. However, extensive cancer screening programs are not recommended in general for patients with VTE. A wide range of antithrombotic drugs including heparin, oral anticoagulants, and platelet inhibitors have been examined in order to study the effect on the prevention and treatment of various cancers. These efforts have resulted in a considerable amount of useful data from animal models and a number of promising reports from retrospective analyses and small-scale trials linking antithrombotic treatment with an increased survival in cancer patients and even a lower risk of primary cancer. However, the clinical implications of these findings must await properly designed and conducted randomized clinical trials.